ASRA MIPS Fact Sheets Revised for 2018

Dec 14, 2017

As we move into the second performance year of the Merit-based Incentive Payment System (MIPS), providers should be aware of some changes to the policies as part of the transition process. To aid in your understanding of these changes and how they may affect you, ASRA's Practice Management Committee has developed two fact sheets.  

Under MIPS, Medicare assesses clinician performance in four categories: (1) quality, (2) cost, (3) clinical practice improvement activities, and (4) advancing care information (previously known as “Meaningful Use”). Medicare will adjust an individual clinician's fee-for-service Part B payments in 2020 in a positive, neutral, or negative manner by up to 5 percent.

For the 2018 MIPS performance year, clinicians who earn at least 15 out of a possible 100 points will avoid a negative payment adjustment in 2020. Clinicians who earn more than 15 total MIPS points will be eligible to receive a positive payment adjustment and those earning less than 15 points will receive a negative payment adjustment. Physicians who earn 70 points or more will be eligible for “exceptional” bonus payments. In addition to earning points for performance in each of the MIPS performance categories, physicians also may earn bonus points that count toward their MIPS total performance score through:

  • Small practice bonus: Physicians in practices consisting of 15 or fewer clinicians and solo practitioners are eligible to receive a small practice bonus score of 5 points. To receive the bonus score, clinicians must participate in MIPS by reporting data on at least one performance category.
  • Complex patient bonus: Physicians may earn a complex patient bonus score of up to 5 points for treating patients who are particularly medically complex and relatively low income. Clinicians do not have to report data for the complex patient bonus. Instead, Medicare will calculate a complex patient bonus for each clinician using claims and other data.

All physicians, physician assistants (PAs), nurse practitioners (NPs), clinical nurse specialists (CNSs), certified registered nurse anesthetists (CRNAs), and groups that include these professionals must participate in MIPS in order to receive Medicare reimbursement, with certain limited exceptions.

The fact sheets provide a guide of selected 2018 MIPS quality measures, clinical practice improvement activities, and advancing care information measures, inclusive of the data submission method necessary for each measure or activity.

ASRA has also developed a fact sheet to help explain how MACRA affects Medicare payments to physicians. Download the sheet here.

For more information on MIPS and MACRA generally, please visit Medicare’s Quality Payment Program website

Read more about ASRA's advocacy efforts.

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