Welcome to MIPS Resource Center

Welcome to EMRSystems ultimate MIPS Resource! Find answers to all your MIPS queries, and help your practice prepare for the future of healthcare.

Explore expert analysis of MACRA & MIPS through:

  • Webinars
  • Whitepapers
  • Blogs
  • Specialty Checklists

Webinar Slides

Tune in to hear our MIPS experts on the final changes on MIPS to how to generate more from patient engagement for a bonus credit score! touch screen technology.

December 13th webinar

Is your practice ready for MIPS? The reporting period for PQRS and Meaningful Use is set to sunset with 2016. Have you reviewed your PQRS feedback reports?

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October 25th webinar

Is your practice ready for MIPS? The implementation deadline is only a few months away and it’s always best to prepare beforehand.

Download

August 16th webinar

How often do your patients hear from you? Do they know you are concerned about their wellbeing? Keeping patients engaged and satisfied.

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Contact us for free consultation

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MIPS Whitepapers

Our whitepapers are written by doctors, for doctors! We cut through the legal jargon to bring you the facts that you and your practice need to know.

Advancing Care Information

Read our unbiased comparison of the seven top EHR vendors in the health IT & prepare your practice for January 2019.

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Clinician Practice Improvement Activities

The ABC’s of MACRA and the future of Meaningful Use is explored in this definitive whitepaper.

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Eligibility and Incentives

Find out if your practice is eligibile under the MIPS pathway, and how you can earn bonus incentives in 2019.

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MIPS Specialty Checklists

  • Cardiology
  • Dermatology
  • Family Medicine
  • Oncology
  • Surgery
  • Internal Medicine
  • Neurology
  • ObGyn
  • Otolaryngology
  • Pediatrics

CMS has determined 20 measure sets for cardiology in the Quality performance category that are further reduced to 7 when filtered to show only high priority measures. Of these 7 measures only Controlling High Blood Pressure is an outcome measure, and of intermediate priority. Measures can be filtered further by Data Submission Method.

Cardiologist clinicians need only submit the following to achieve a full score in Quality:
Measure Measure Type High Priority Measure Submission Method

Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Preoperative Evaluation in Low Risk Surgery Patients

Efficiency
Registry

Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Routine Testing After Percutaneous Coronary Intervention (PCI)
Efficiency
Registry

Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Testing in Asymptomatic, Low-Risk Patients
Efficiency
Registry

Care Plan
Process
Claims, Registry

Closing the Referral Loop: Receipt of Specialist Report
Process
EHR

Controlling High Blood Pressure
Intermediate Outcome
Claims, EHR, CMS Web Interface, Registry

Documentation of Current Medications in the Medical Record
Process
Claims, EHR, Registry

To find greater detail about Quality measures and reporting requirements download our Quality whitepaper.

Download Whitepaper

There are 11 specialty specific quality measures outlined by CMS for dermatology. Out of these only 7 are high priority measures. Dermatology clinicians can further filter these measures by data submission method. There is only one high priority outcome method for dermatology which fulfills the CMS requirements. Dermatology clinicians only need to fill the following to achieve their Quality measure requirements.

Measure Measure Type High Priority Measure Submission Method

Biopsy Follow-Up
Process
Registry

Closing the Referral Loop: Receipt of Specialist Report
Process
EHR

Documentation of Current Medications in the Medical Record
Process
Claims, EHR, Registry

Melanoma: Continuity of Care - Recall System
Structure
Registry

Melanoma: Coordination of Care
Process
Registry

Melanoma: Overutilization of Imaging Studies in Melanoma
Process
Registry

Psoriasis: Clinical Response to Oral Systemic or Biologic Medications
Outcome
Claims, Registry

To find out about earning bonus credit in Quality measures, download our definitive whitepaper.

Download Whitepaper

There are 55 quality measures specific to Family Medicine listed by CMS, yet only 25 of them are high priority measures. We have listed eight measures for your convenience, two of which are outcome measures for you to choose from, fulfilling the reporting requirement for this category.

Measure Measure Type High Priority Measure Submission Method

CAHPS for PQRS Clinician/Group Survey
Patient Engagement/Experience
CSV

Care Plan
Process
Claims, Registry

Depression Remission at Twelve Months
Outcome
EHR, CMS Web Interface, Registry

Documentation of Current Medications in the Medical Record
Process
Claims, EHR, Registry

Elder Maltreatment Screen and Follow-Up Plan
Process
Claims, Registry

Pain Brought Under Control within 48 Hours
Outcome
Registry

Use of Imaging Studies for Low Back Pain
Process
EHR

Osteoarthritis (OA): Function and Pain Assessment
Process
Claims, Registry

To find out about bonus credit measures under MIPS download our Quality specific whitepaper today!

Download Whitepaper

CMS has determined 19 measure sets for general oncology in the Quality performance category that are further reduced to 13 when filtered to show only high priority measures. Out of the thirteen measures three are outcome measures. Oncologist clinicians need only submit six of the following to gain a full score in the Quality category:

Measure Measure Type High Priority Measure Submission Method

Care Plan
Process
Claims, Registry

Closing the Referral Loop: Receipt of Specialist Report
Process
EHR

Documentation of Current Medications in the Medical Record
Process
Claims, EHR, Registry

HER2 Negative or Undocumented Breast Cancer Patients Spared Treatment with HER2-Targeted Therapies
Process
Registry

Oncology: Medical and Radiation - Pain Intensity Quantified
Process
EHR, Registry

Patients with Metastatic Colorectal Cancer and KRAS Gene Mutation Spared Treatment with Anti-epidermal Growth Factor Receptor (EGFR) Monoclonal Antibodies
Process
Registry

Proportion Admitted to Hospice for less than 3 days
Outcome
Registry

Proportion Admitted to the Intensive Care Unit (ICU) in the Last 30 Days of Life
Outcome
Registry

Proportion Not Admitted To Hospice
Process
Registry

Proportion of Patients who Died from Cancer with more than One Emergency Department Visit in the Last 30 Days of Life
Outcome
Registry

Proportion Receiving Chemotherapy in the Last 14 Days of Life
Process
Registry

Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

Process
Registry

Trastuzumab Received By Patients with AJCC Stage I (T1c) - III and HER2 Positive Breast Cancer Receiving Adjuvant Chemotherapy
Process
Registry

For greater detail on Quality measures and reporting requirements download our Quality white paper.

Download Whitepaper

CMS has listed 14 quality performance measures for General Surgery, which are reduced to 10 once filtered for high priority measures. Out of the ten measures four are outcome measures. General surgery clinicians only need to report six of the following measures to gain a full Quality score:

Measure Measure Type High Priority Measure Submission Method

Anastomotic Leak Intervention
Outcome
Registry

Anastomotic Leak Intervention
Outcome
Registry

Closing the Referral Loop: Receipt of Specialist Report
Process
EHR

Documentation of Current Medications in the Medical Record
Process
Claims, EHR, Registry

Patient-Centered Surgical Risk Assessment and Communication
Process
Registry

Perioperative Care: Selection of Prophylactic Antibiotic - First OR Second Generation Cephalosporin
Process
Claims, Registry

Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)
Process
Claims, Registry

Surgical Site Infection (SSI)
Outcome
Registry

Unplanned Hospital Readmission within 30 Days of Principal Procedure
Outcome
Registry

Unplanned Reoperation within the 30 Day Postoperative Period
Outcome
Registry

For more information on Quality measures and reporting requirements download our Quality white paper.

Download Whitepaper

The Internal Medicine specialty set has 37 listed measures by CMS. These are reduced to 14 after they are filtered for high priority measures. Out of the 14, only two are intermediate outcome measures for clinicians to choose from. Internal medicine clinicians only need to report six of the following measures to gain a full Quality score:

Measure Measure Type High Priority Measure Submission Method

Adult Sinusitis: Antibiotic Prescribed for Acute Sinusitis (Overuse)
Process
Registry

Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use)
Process
Registry

Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse)
Efficiency
Registry

Adult Sinusitis: More than One Computerized Tomography (CT) Scan within 90 Days for Chronic Sinusitis (Overuse)
Efficiency
Registry

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
Process
Registry

Care Plan
Process
Claims, Registry

Controlling High Blood Pressure
Intermediate Outcome
Claims, EHR, CMS Web Interface, Registry

Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Intermediate Outcome
Claims, EHR, CMS Web Interface, Registry

Documentation of Current Medications in the Medical Record
Process
Claims, EHR, Registry

Elder Maltreatment Screen and Follow-Up Plan
Process
Claims, Registry

Falls: Plan of Care
Process
Claims, Registry

Falls: Risk Assessment
Process
Claims, Registry

Osteoarthritis (OA): Function and Pain Assessment
Process
Claims, Registry

Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older
Process
Claims, Registry

For more information on Quality measures and reporting requirements download our Quality white paper.

Download Whitepaper

There are 26 Quality measures in total outlined by CMS for clinicians practicing Neurology, out of which 10 have been classified as high priority measures. Since one of these is also an outcome measure, clinicians can fulfill their Quality measure requirements by reporting six of the measures below:

Measure Measure Type High Priority Measure Submission Method

Amyotrophic Lateral Sclerosis (ALS) Patient Care Preferences
Process
Registry

Care Plan
Process
Claims, Registry

Closing the Referral Loop: Receipt of Specialist Report
Process
EHR

Dementia: Caregiver Education and Support
Process
Registry

Dementia: Counseling Regarding Safety Concerns
Process
Registry

Documentation of Current Medications in the Medical Record
Process
Claims, EHR, Registry

Overuse of Neuroimaging For Patients With Primary Headache And A Normal Neurological Examination

Efficiency
Claims, Registry

Parkinson's Disease: Parkinson's Disease Medical and Surgical Treatment Options Reviewed
Process
Registry

Parkinson's Disease: Rehabilitative Therapy Options
Process
Registry

Quality of Life Assessment for Patients With Primary Headache Disorders
Outcome
Claims, Registry

To find out how to secure bonus scores in all MIPS categories download our whitepapers today!

Download Whitepaper

CMS has listed 24 Quality measures for Obstetrics/Gynecology out of which only 12 are high priority measures. There are over three high priority outcomes for clinicians to choose from, fulfilling all of CMS Quality measure requirements if clinicians only report six of the following:

Measure Measure Type High Priority Measure Submission Method

Appropriate Workup Prior to Endometrial Ablation
Process
Registry

Biopsy Follow-Up
Process
Registry

Care Plan
Process
Claims, Registry

Closing the Referral Loop: Receipt of Specialist Report
Process
EHR

Controlling High Blood Pressure
Intermediate Outcome
Claims, EHR, CMS Web Interface, Registry

Documentation of Current Medications in the Medical Record
Process
Claims, EHR, Registry

Non-Recommended Cervical Cancer Screening in Adolescent Females
Process
Registry

Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse to Detect Lower Urinary Tract Injury
Process
Claims, Registry

Proportion of Patients Sustaining a Bladder Injury at the Time of any Pelvic Organ Prolapse Repair
Outcome
Registry

Proportion of Patients Sustaining a Bowel Injury at the time of any Pelvic Organ Prolapse Repair

Outcome
Registry

Proportion of Patients Sustaining a Ureter Injury at the Time of any Pelvic Organ Prolapse Repair

Outcome
Registry

Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older
Outcome
Claims, Registry

To find out more about Quality measures, and how to gain bonus credit, download our whitepaper today.

Download Whitepaper

For the Otolaryngology specialty, CMS has listed 18 Quality measures, of which 13 are high priority measures. The list also contains one high priority outcome measures ensuring that clinicians need only follow six of the following to achieve their full Quality category score.

Measure Measure Type High Priority Measure Submission Method

Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy - Avoidance of Inappropriate Use
Process
Claims, Registry

Acute Otitis Externa (AOE): Topical Therapy
Process
Claims, Registry

Adult Sinusitis: Antibiotic Prescribed for Acute Sinusitis (Overuse)
Process
Registry

Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use)
Process
Registry

Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse)
Efficiency
Registry

Adult Sinusitis: More than One Computerized Tomography (CT) Scan Within 90 Days for Chronic Sinusitis (Overuse)
Efficiency
Registry

Care Plan
Process
Claims, Registry

Closing the Referral Loop: Receipt of Specialist Report
Process
EHR

Documentation of Current Medications in the Medical Record
Process
Claims, EHR, Registry

Patient-Centered Surgical Risk Assessment and Communication
Process
Registry

Perioperative Care: Selection of Prophylactic Antibiotic - First OR Second Generation Cephalosporin
Process
Claims, Registry

Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)
Process
Claims, Registry

Surgical Site Infection (SSI)
Outcome
Claims, Registry

Surgical Site Infection (SSI)
Outcome
Claims, Registry

Learn more about MIPS measures and how to attain the perfect score for up to three times positive payment adjustments.

Download Whitepaper

CMS has listed 18 quality performance measure sets for general pediatrics, out of which only 7 are high priority measures. Since the pediatric specialty set doesn’t have any outcome measures clinicians can submit six of the following high priority measures to gain a full score in the Quality category:

Measure Measure Type High Priority Measure Submission Method

Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy - Avoidance of Inappropriate Use
Process
Claims, Registry

Acute Otitis Externa (AOE): Topical Therapy
Process
Claims, Registry

Appropriate Testing for Children with Pharyngitis
Process
EHR, Registry

Appropriate Treatment for Children with Upper Respiratory Infection (URI)
Process
EHR, Registry

Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment
Process
EHR

Follow-Up After Hospitalization for Mental Illness (FUH)
Process
Registry

Medication Management for People with Asthma
Process
Registry

For more information on Quality measures and reporting requirements download our Quality white paper.

Download Whitepaper

Frequently Asked Questions

The Medicare Access and CHIP Reauthorization Act (MACRA) repeals the Sustainable Growth Rate (SGR) formula, that was used to calculate payment cuts for physicians, and replaces it with two payment tracks:

  • Merit-based Incentive Payment System (MIPS)
  • Alternate Payment Models (APMs)

The Merit-based Incentive Payment System (MIPS) merges the existing quality reporting programs Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and Meaningful Use, with an additional performance category to make a single system.

The four categories assess physician performance, consolidating a composite score on a 0 – 100 point scale:

  • Quality (PQRS) – 60%
  • Advancing Care Information (MU) – 25%
  • Clinical Practice Improvement Activities – 15%
  • Resource Use (VBM) – 0% for CY2019

Quality – Clinicians are required to report at least 6 measures; one of which must be from the outcome category, and three population based methods.

Advancing Care Information (ACI) – Clinicians can choose to report 9 measures from a selection of 15 for a minimum of 90 days. To gain additional credit clinicians can submit measures through public health and clinical data registry or using a certified EHR.

Clinical Practice Improvement Activities (CPIA) – Clinicians are required to certify engagement in 4 activities for a minimum of 90 days to gain full credit. Non-patient facing, or rural area health workers need only report 2.

Resource Use - CMS doesn’t require any reporting for the Resource Use category in CY2019. CMS will use 2019 performance year to determine measure benchmarks for performance year 2018. Clinicians won’t be required to report measures as they will be automatically collected through submitted claims data

Payment adjustment years are marked two years after the performance year in the MIPS timeline. The first adjustment year for MIPS is 2019, with negative and positive payment adjustments slated at 4%. These will increase up to 9% in 2022. Negative adjustments are capped, but physicians can earn up to three times bonus on their positive adjustments depending on their score.

It is possible for clinicians to participate in MIPS without an EHR, but they will not be eligible for any performance points in the ACI category that holds 25% weightage on overall physician score.

Clinicians can still report measures through claims or qualified registry but it will be far more arduous without an EHR because qualified registry options require manual data collections process.

The following have been outlined as exempt from MIPS:

  • Providers new to Medicare
  • Providers who fall below the proposed benchmark of 100 patients and $30,000 Medicare payment volume
  • Providers who qualify for payment under APMs

There are many ways to prepare for 2019 and beyond. Consult our detailed MIPS Success Plan in our MIPS Resource.

Alternative Payment Models (APMs) are added incentive payments to ensure providers aim for cost efficient, high quality patient care. These can apply to a specific clinical condition, a population, or care based episode. Clinicians take on some risk under the Advanced APMs approach, and can earn a 5% incentive payment by going further in improving patient care.

The following are eligible under APMs for the performance period starting in 2019:

  • Comprehensive Primary Care Plus (CPC+)
  • Medicare Shared Savings Tracks 2 and 3
  • Next Generation ACO Model

To receive incentive payments under APMs providers must meet the following requirements:

  • Use of quality measures comparable to measures under MIPS
  • Use of a certified electronic health record (EHR) technology
  • Assumes more than a “nominal financial risk”, or a medical home expanded under the CMMI

MACRA final rule strives to help small practices. The minimum threshold to be eligible for MIPS has been expanded to $30,000 or less than or equal to 100 Medicare patients. Small practices that still wish to take part in MIPS can do so by forming “virtual groups” and combine their MIPS reporting.

MACRA has also mandated that $100 million will be available to MIPS eligible clinicians in small practices, health professional shortage areas (HPSAs), and rural areas; in an effort to educate and maximize participation.

MIPS Certified EHR Vendors

To excel in the first performance year, get the EHR that will help in automatic MIPS reporting. Explore the top vendors prepared for CY2019, and choose one that is a best fit for your practice.

View All

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