Learn About MACRA
The Merit-Based Incentive Payment System
One half of the new Medicare Quality Payment Program (QPP) created by MACRA, participants in the Merit-Based Incentive Payment System will receive a MIPS final performance score based on their participation in four individual performance categories.
If you see less than 200 Medicare Part B patients during a MIPS reporting year OR have Medicare Part B billing charges less than or equal to $90,000, you are excluded from participation in the Quality Payment Program. CMS will review your previous Medicare Part B patient and billing volume to determine if you are excluded. CMS has created a lookup tool where physicians can verify their MIPS eligibility status. Visit www.qpp.cms.gov.
Eligible clinicians must submit data on:
- Six quality measures, including one outcome or high priority measure
- Minimum 2 IAs, depending on practice size
- Base measures plus at least one performance measure in the ACI category
| Performance Component | Minimum Reporting Period For 2018 |
|---|---|
| Quality | 12-months |
| Cost | 12-months |
| Improvement Activities | 90-days |
| Advancing Care Information | 90-days |
 | Replaces the Physician Quality Reporting System (PQRS) Percentage of 2017 MIPS Final Score: 60% | |||
|---|---|---|---|---|
| How this Performance Category applies to you, by Practice Type/Setting | To Avoid a Penalty | To Receive a Payment Bonus | MIPS Performance Category Score Bonus Opportunities | ASPS Developed Support |
Solo | Submit 1 quality measure, 1 Clinical Practice Improvement Activity, or the core ACI measures by CMS Claims (deadline: Dec 31, 2017), Qualified Registry or Qualified Clinical Data Registry (deadline: March 31, 2018 - please note, submission deadlines may vary by the mechanism you choose) NOTE: For 2017, each MIPS performance category has one minimum threshold activity. Completing one of these will allow you to avoid a penalty program-wide | Eligibility for Small Bonus: Submit at least 6 quality measures on 90 consecutive days of data (You must begin collecting data by October 2, 2017) Eligibility for Larger Bonus: Submit a full year of data Submit 6 quality measures, including at least one outcome measure; or Submit 6 quality measures within the Plastic Surgery Measure Set, including 1 outcome measure | 2 bonus points for each outcome and patient experience measure reported Bonus points are available for measures that are not scored* as long as the measure has the required case minimum and data completeness 1 bonus point for each measure submitted with end-to-end electronic reporting for a quality measure under certain criteria * Those not included in the top 6 measures for the quality performance category score | ASPS has tools to help you track, measure, and report on those measures, as well as additional relevant measures Learn more about the ASPS QCDR at plasticsurgery.org/QCDR. |
CMS Web Interface (≥25 MIPS-eligible clinicians) | Submit 15 quality measures for 1 full year | Eligibility for Small Bonus: Submit at least 6 quality measures on 90 consecutive days of data. (You must begin collecting data by October 2, 2017) Eligibility for Up to 4% Bonus: On 90 consecutive days of data (you must begin collecting data by October 2, 2017):
| 2 bonus points for each outcome and patient experience measure reported Bonus points are available for measures that are not scored* as long as the measure has the required case minimum and data completeness 1 bonus point for each measure submitted with end-to-end electronic reporting for a quality measure under certain criteria * Those not included in the top 6 measures for the quality performance category score | The Plastic Surgery Measure set includes 11 measures that are recommended for the specialty ASPS has tools to help you track, measure, and report on those measures, as well as additional relevant measures |
Advanced Alternative Payment Model | Report quality measures through your APM. No additional activity is required for this performance category | |||
| Replaces the Physician Quality Reporting System (PQRS) Percentage of 2017 MIPS Final Score: 60% |
|---|---|
| Solo, Small Group (≤15 MIPS-eligible clinicians), Other Group (≥16 MIPS-eligible clinicians) | |
To Avoid a PenaltySubmit 1 quality measure, 1 Clinical Practice Improvement Activity, or the core ACI measures by CMS Claims (deadline: Dec 31, 2017), Qualified Registry or Qualified Clinical Data Registry (deadline: March 31, 2018 - please note, submission deadlines may vary by the mechanism you choose) NOTE: For 2017, each MIPS performance category has one minimum threshold activity. Completing one of these will allow you to avoid a penalty program-wide To Receive a Payment BonusEligibility for Small Bonus: Submit 2 or more quality measures on 90 consecutive days of data (You must begin collecting data by October 2, 2017) Eligibility for Larger Bonus: Submit a full year of data Submit 6 quality measures, including at least 1 outcome measure; or Submit 6 quality measures within the Plastic Surgery Measure Set, including 1 outcome measure MIPS Performance Category Score Bonus Opportunities2 bonus points for each outcome and patient experience measure reported Bonus points are available for measures that are not scored* as long as the measure has the required case minimum and data completeness 1 bonus point for each measure submitted with end-to-end electronic reporting for a quality measure under certain criteria * Those not included in the top 6 measures for the quality performance category score ASPS Developed SupportASPS has tools to help you track, measure, and report on those measures, as well as additional relevant measures Learn more about the ASPS QCDR at plasticsurgery.org/QCDR. | |
| CMS Web Interface (≥25 MIPS-eligible clinicians) | |
To Avoid a PenaltySubmit 15 quality measures for 1 full year To Receive a Payment BonusEligibility for Small Bonus: Submit 2 or more quality measures on 90 consecutive days of data. (You must begin collecting data by October 2, 2017) Eligibility for Up to 4% Bonus: On 90 consecutive days of data (you must begin collecting data by October 2, 2017):
MIPS Performance Category Score Bonus Opportunities2 bonus points for each outcome and patient experience measure reported Bonus points are available for measures that are not scored* as long as the measure has the required case minimum and data completeness 1 bonus point for each measure submitted with end-to-end electronic reporting for a quality measure under certain criteria * Those not included in the top 6 measures for the quality performance category score ASPS Developed SupportThe Plastic Surgery Measure set includes 11 measures that are recommended for the specialty ASPS has tools to help you track, measure, and report on those measures, as well as additional relevant measures | |
| Advanced Alternative Payment Model | |
Report quality measures through your APM. No additional activity is required for this performance category | |
 | This is a new reporting category, with no predecessor among federal pay-for-performance programs Percentage of 2017 MIPS Final Score: 15% | |||
|---|---|---|---|---|
| How this Performance Category applies to you, by Practice Type/Setting | To Avoid a Penalty | To Receive a Payment Bonus | MIPS Performance Category Score Bonus Opportunities | ASPS Developed Support |
Solo | If opting to report the IA category instead of quality or ACI, attest to at least 1 medium-weighted improvement activity for 90 days. The activities must begin no later than the 90-day period beginning October 2, 2017 | Eligibility for Small Incentive: Earn a minimum of 20 points Eligibility for Larger Incentive: Earn 40 points Medium-weighted activities are 20 points each; High-weighted activities are 40 points each The activities must begin no later than the 90-day period beginning October 2, 2017 | Awarded to clinicians who can attest to using CEHRT functions when they carry out the activity | ASPS has identified the IAs most relevant to plastic surgery and other IAs that may be useful – or already in place – at some practices |
Other Group (≥16 MIPS-eligible clinicians) | Attest to at least 1 medium-weighted improvement activity for 90 days. The activities must begin no later than the 90-day period beginning October 2, 2017 | Eligibility for Small Incentive: Earn a minimum of 10 points, maximum 30 points Eligibility for Larger Incentive: Earn 40 points, in any combination of high and medium weighted activities Medium-weighted activities are 10 points each; High-weighted activities are 20 points each Activities must begin no later than the 90-day period beginning October 2, 2017 | Awarded to clinicians who can attest to using CEHRT functions when they carry out the activity | ASPS has identified the IAs most relevant to plastic surgery and other CPIAs that may be useful – or already in place – at some practices |
Advanced Alternative Payment Model Participants in:
| Automatically receive points based on the requirements of the program | |||
| This is a new reporting category, with no predecessor among federal pay-for-performance programs Percentage of 2017 MIPS Final Score: 15% |
|---|---|
| Solo, Small Group (≤15 MIPS-eligible clinicians), Practitioners in a rural or health professional shortage area | |
To Avoid a PenaltyIf opting to report the IA category instead of quality or ACI, attest to at least 1 medium-weighted improvement activity for 90 days.The activities must begin no later than the 90-day period beginning October 2, 2017 To Receive a Payment BonusEligibility for Small Incentive: Earn a minimum of 20 points Eligibility for Larger Incentive: Earn 40 points Medium-weighted activities are 20 points each; High-weighted activities are 40 points each The activities must begin no later than the 90-day period beginning October 2, 2017 MIPS Performance Category Score Bonus OpportunitiesAwarded to clinicians who can attest to using CEHRT functions when they carry out the activity ASPS Developed SupportASPS has identified the IAs most relevant to plastic surgery and other IAs that may be useful – or already in place – at some practices | |
| Other Group (≥16 MIPS-eligible clinicians) | |
To Avoid a PenaltyAttest to at least 1 medium-weighted improvement activity for 90 days. The activities must begin no later than the 90-day period beginning October 2, 2017 To Receive a Payment BonusEligibility for Small Incentive: Earn a minimum of 10 points, maximum 30 points Eligibility for Larger Incentive: Earn 40 points, in any combination of high and medium weighted activities Medium-weighted activities are 10 points each; High-weighted activities are 20 points each Activities must begin no later than the 90-day period beginning October 2, 2017 MIPS Performance Category Score Bonus OpportunitiesAwarded to clinicians who can attest to using CEHRT functions when they carry out the activity ASPS Developed SupportASPS has identified the IAs most relevant to plastic surgery and other CPIAs that may be useful – or already in place – at some practices | |
| Advanced Alternative Payment Model Participants in: certified patient-centered medical homes, comparable specialty practices, an APM designated as a Medical Home Model | |
Automatically receive points based on the requirements of the program | |
 | Replaces the federal Electronic Health Records Incentive Program, also known as Meaningful Use Percentage of 2017 MIPS Final Score: 25% | |||
|---|---|---|---|---|
| How this Performance Category applies to you, by Practice Type/Setting | To Avoid a Penalty | To Receive a Payment Bonus | MIPS Performance Category Score Bonus Opportunities | ASPS Developed Support |
Solo | Begin reporting on all of the required (base) measures for a minimum of 1 patient for 90 days by October 2, 2017:
| Eligibility for Small Incentive: Report on the base measures plus at least 1 ACI performance score measure for 90 days Eligibility for Larger Incentive: To earn a higher score, you can report additional performance measures in an attempt to receive 100% You must report on data covering at least 90 days, beginning no later than October 2, 2017 | Report Public Health and Clinical Data Registry Reporting measures* Use certified EHR technology to complete certain improvement activities in the improvement activities performance category * these are generally not accessible to plastic surgeons; however, those in a multi-specialty group practice may be able to report these based on another provider's access | ACI can be reported via the ASPS QCDR. (Coming Soon) |
| Replaces the federal Electronic Health Records Incentive Program, also known as Meaningful Use Percentage of 2017 MIPS Final Score: 25% |
|---|---|
| Solo, Small Group (≤15 MIPS-eligible clinicians), Other Group (≥16 MIPS-eligible clinicians), Advanced Alternative Payment Model | |
To Avoid a PenaltyBegin reporting on all of the required (base) measures for a minimum of 1 patient for 90 days by October 2, 2017:
To Receive a Payment BonusEligibility for Small Incentive: Report on the base measures plus at least 1 ACI performance score measure for 90 days Eligibility for Larger Incentive: To earn a higher score, you can report additional performance measures in an attempt to receive 100% You must report on data covering at least 90 days, beginning no later than October 2, 2017 MIPS Performance Category Score Bonus OpportunitiesReport Public Health and Clinical Data Registry Reporting measures* Use certified EHR technology to complete certain improvement activities in the improvement activities performance category * These are generally not accessible to plastic surgeons; however, those in a multi-specialty group practice may be able to report these based on another provider's access ASPS Developed SupportACI can be reported via the ASPS QCDR. (Coming Soon) | |
 | Replaces the Value-Based Modifier Percentage of 2017 MIPS Final Score: 0% | |||
|---|---|---|---|---|
| How this Performance Category applies to you, by Practice Type/Setting | To Avoid a Penalty | To Receive a Payment Bonus | MIPS Performance Category Score Bonus Opportunities | ASPS Developed Support |
| In 2017, this will be calculated based on adjudicated claims. No submission required | You will be scored on your resource use in the future, most likely beginning in 2018. ASPS has tools to help you identify opportunities to make your resource use more efficient | |||
| Replaces the Value-Based Modifier Percentage of 2017 MIPS Final Score: 0% |
|---|---|
In 2017, this will be calculated based on adjudicated claims. No submission required ASPS Developed SupportYou will be scored on your resource use in the future, most likely beginning in 2018. ASPS has tools to help you identify opportunities to make your resource use more efficient | |
You can obtain a Merit-based Incentive Payment System (MIPS) final performance score by participating in some or all of the four MIPS performance categories: (1) the Advancing Care Information (ACI) Performance Category; (2) the Improvement Activities (IA) Performance Category; (3) the Quality Performance Category; and (4) the COST Performance Category. The more you participate, the higher your score.
Your performance in each category is scored individually based on whether and how well you conduct activities specified within it. The individual MIPS performance category scores are weighted differently (for 2018, the weights are: ACI - 25%; CPIAs - 15%; Quality - 50%; COST - 10%), and are aggregated to produce a MIPS final performance score.
Your MIPS final performance score is used to benchmark your performance relative to all other MIPS physicians. Your Part B payments will be increased, decreased or remain neutral based on how your score ranks relative to the full field of final scores.
Additional Help Understanding Scoring
CMS recognizes Virtual Groups as an additional participation option under MIPS. A Virtual Group is a combination of 2 or more Taxpayer Identification Numbers (TINs) made up of solo practitioners and/or groups of 10 or fewer eligible clinicians who come together "virtually" (no matter specialty or location) with others to participate in MIPS for a yearly performance period. To be eligible to join or form a virtual group you would need to be a solo practitioner or group who exceeds the low volume threshold.
- Virtual Group Fact Sheet
- 2020 Election Process Guide
- To be part of a virtual group for the 2020 MIPS performance year, applications must be submitted to CMS via e-mail by Tuesday, December 31, 2019