MIPS Resources

Clarify your path to success with MACRA/MIPS support from LTPAC leaders.

As the stakes get higher and the program increases in complexity, GEHRIMED has made MIPS as easy to understand as possible. Picking the best strategy for your practice can be confusing. We understand that every practice has an optimum participation pace, and we will provide MACRA/MIPS support that helps you become more successful at reporting quality and obtaining the highest scores under the MIPS program. From avoiding penalties, to earning incentives, we’re here to help.


Important MIPS Update July 17, 2018

CMS Releases Proposed Rule for MIPS 2019

On July 12, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to update the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP), which encompasses the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). The proposed rule would make changes in the third year of the Quality Payment Program (2019) and incorporates proposed changes to the Medicaid Promoting Interoperability (PI) program (formerly Meaningful Use), and the Medicare Shared Savings Program (MSSP ACO’s).


GPM is in the process of analyzing the proposed rule for impact to LTC providers and to our software product. We strive to actively support and improve your workflow, while ensuring that we continue to capture the required information to maintain compliance and quality reporting requirements.


Proposed Changes for the 2019 MIPS Performance Period


  • Reweighting MIPS categories:
    • Cost – 15% (initial proposed update in 2018 rulemaking was 30%)
    • Quality – 45%
    • PI (formerly ACI) – 25%
    • IA – 15%
  • Performance periods remain the same:
    • Quality – Full Year
    • Cost – Full Year
    • IA – 90 days
    • PI – 90 days
  • Minimum threshold increased from 15 to 30 points. Exceptional performance threshold up from 70 to 80 points.
  • Maintaining the low-volume threshold for MIPS exemption at $90,000 or less in part B allowed charges or 200 or fewer Medicare beneficiaries.
    • Adding a third exclusion for clinicians providing 200 or fewer covered professional services under the PFS.
  • Small practice bonus points will be added to the Quality category, not the overall MIPS score.
  • Continuance of the complex patient bonus and end to end reporting bonus.
  • Allowing individuals and groups to submit MIPS data using multiple submission types per category.
  • Implementing facility-based MIPS scoring that would allow “facility-based clinicians” to use the Hospital Value-Based Purchasing Program performance for the MIPS Quality and Cost categories.
  • Alignment of MIPS PI measures with those used in the Medicaid PI program.
  • New Proposed SNF Measure Set (located on pp. 1417- 1419 of the proposed rule)

Other proposals include changes to Evaluation and Management (E/M), telehealth reimbursement, and the proposed removal of four CMS-WI measures.



GPM Regulatory Staff have compiled a Table of Contents of the 1,473-page document, to enable easier navigation. It is available in the GEHRIMED Online Community.


Below is a link to the CMS fact sheet and link to the proposed rule (unpublished version):


Proposed Rule Fact Sheet

2019 Proposed Rule (unpublished version)


We will continue to keep you informed.

  • MIPS is complicated. We make it easier.

    Navigating MIPS can be stressful, even if you’re a seasoned LTPAC practitioner. Here are some basics to get you started.

  • What is MIPS?

    The Merit-Based Incentive Payment System (MIPS) program leverages and augments PQRS, Value-Based Modifier (VBM) and Meaningful Use requirements into a cohesive program. MIPS will also include the introduction of a new reporting category, Improvement Activities.

  • When will the payment adjustments from MIPS begin?

    The payment adjustments will begin in 2020; however, the payment adjustment schedule will be based on 2018 performance scores (scores will be positive, zero, or negative).

  • How is the budget supported for MIPS?

    MIPS is a budget-neutral program. The incentives are funded by the penalties incurred by other eligible clinicians.

  • What are the MIPS Components and Weights?

    MIPS will become increasingly more difficult in the subsequent years. While Improvement Activities and Advancing Care information weights remain constant, Quality decreases and Resource Use weight increases significantly over time.


    Year: 2020*

    • Quality: 50%
    • Resource Use: 10%
    • Improvement Activities: 15%
    • Advancing Care Information: 25%

    *Based on calendar year (CY) 2018 participation


    Year: 2021**

    • Quality: 30%
    • Resource Use: 30%
    • Improvement Activities: 15%
    • Advancing Care Information: 25%

    **Based on CY 2019 Participation

  • What is the Advancing Care Information (ACI) hardship exemption?

    If clinicians face significant hardship and are unable to report ACI measures, they can apply to have their ACI performance category score weighted to zero. However, doing so will increase the Quality component weight from 50% to 75%.

  • Are the MIPS performance scores made publically available?

    Yes. The MIPS Eligible Clinician’s performance scores are publicly available on the CMS Physician Compare website.

  • What are the requirements for end-to-end electronic reporting?

    • Use a CEHRT to recorded the measure’s demographic and clinical data elements.
    • Export and transmit the measure data electronically to a third party. The third party, such as a registry, uses automated software to aggregate the measure data, calculate measures, perform any filtering of measurement data, and submit the data electronically to CMS.


    GEHRIMED is both a Qualified Registry and a QCDR.

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