The Merit-based Incentive Payment System: What is it?

One approach to take part in the Quality Payment Program is through the Merit-based Incentive Payment System (MIPS). In accordance with MIPS, CMS assesses your performance in a number of categories that enhance the quality and value of the healthcare system. Quality Class for the Quality category, 40% of the MIPS Score Sixty (60) performance points are require in order to receive full credit. By investigating these measures and

data for each measure over the course of the 12-month performance period, the majority of doctors must choose 6 measures, including 1 outcome/high priority measure (January 1- December 31, 2021).

NOTE: If at least one quality measure is reported, clinicians in SMALL practices automatically receive six points in their quality category. The modest practice bonus is what we refer to as.

15% of the MIPS score is based on improvement activity.

Simplest category and point system! The improvement activity (IA) category has a full credit requirement of forty (40) performance points. When practices finish: they will obtain full credit for the IA category.

  • one high-weighted activity and
  • two medium-weighted activities,
  • or two high-weighted activities

Four moderately weighted activities.

How Should Data Be Submitte? Depending on the sort of submitter you are, you can use any one of three submission categories for improvement activities. The various submission types are:

  • Register and attest
  • Register and upload
  • Direct API submission

Category: Promoting Interoperability MIPS Score: 25%

Airfood recipe: To receive full credit for the promoting interoperability (PI) category, one needs 100 performance points. Any needed PI measures that are not reported will be disregarded. The points are transferred to another, designated PI measure when a measure is excluded. Unless an exclusion is claime, you must provide collected data for specific measures from each of the four target measures for 90 straight days (or more) in 2021.

Use of a 2015 edition certified electronic health record (EHR) and providing your EHR’s CMS Identification code from the Certified Health Product List are additional requirements for this category. You must also respond “yes” to the following questions.

the security risk analysis measure, the ONC Direct Review Attestation, and the Prevention of Information Blocking Attestation.

Cost Category accounts for 20% of the MIPS score.


The cost of services provided to Medicare patients related to a hospital stay, the cost of items and services provided, and the overall cost of care provided to Medicare patients with a focus on the primary care they received will all be evaluated by CMS’s cost measures for the performance year 2021.

CMS compares performance on a measure to a benchmark to establish measure achievement points. Instead, then using historical benchmarks, CMS creates cost measure benchmarks using performance data from the performance period.

A further resource for this category is the Cost Quick Start Guide.

Step 3: Recognize How 2021 MIPS Payment Adjustments Will Be Affected by COVID-19 Relief Efforts

All medical professionals in the United States and its territories have been affecte by the COVID-19 epidemic. CMS is aware that not all practices have been significantly impacte by COVID-19, though. Due to the ongoing COVID-19 public health emergency, CMS will continue to accept requests for reweighting of performance categories from physicians, groups, virtual groups, and APM Entities for PY2021. This will be done within the authority of the extraordinary and uncontrollable circumstances policy.

Clinicians can use one of two exception applications in PY2021:

If you experience an extreme and uncontrollable circumstance or a public health emergency, such as COVID-19, that is beyond your control, you can use the Extreme and Uncontrollable Circumstances Exception application to request reweighting for any or all performance categories.

If you meet the requirements for one of the reasons listed below, you may request reweighting particularly for the Promoting Interoperability performance category through the MIPS Promoting Interoperability Performance Category Hardship Exception application. The aforementioned reasons are all listed in this application:

  • You run a little practice.
  • You no longer certify EHR technology.
  • You don’t have enough Internet connectivity.
  • You are dealing with serious and unmanageable events, such a calamity, the closing of your clinic, severe financial hardship, or vendor problems.
  • You have no control over whether CEHRT is available.

If your application is accepte, what happens next?

You won’t need to provide a report for the specified MIPS performance category or categories if your application is accepte, and those categories will be reweighte.

The deadline for applications is December 31, 2021 at 8 PM ET.

Fourth Step: Report Categories Base on YOUR Situation

The MIPS payment adjustment for your composite score is determined by the MIPS 2021 final rule. Keep in mind that you just need 60 points to avoid the 2023 -9% negative payment adjustment:

You don’t have an EHR, which is one of the scenarios to avoid the adjustment.

  • You CAN still take part in MIPS even if your EHR is not approve for the 2015 edition. As a SMALL practice, you are eligible to report the Quality and IA categories and request a PI Hardship Exception.
  • In case two, you have an EHR. Provide you submit a PI Hardship Exception application and it is grante, you can submit data in the Quality, IA, and PI categories or just the Quality and IA categories if you have a 2015 edition certifie HER.
  • The PI category is automatically reweighte in scenario three. CMS will automatically reassign the PI category points to the Quality category if you fall within one of the physician types indicated below. As a result, in order to receive 60 points, you simply need to report in the Quality and IA categories.


Situation 4: A PI Hardship Exception Application that was approve results in a reweighting of the PI category. You may submit an application for a PI Hardship Exception if you are a clinician or group and one of the following conditions applies. You only need to report the Quality and IA categories if the application is approve.

Submit Your Data in Step 5

Between January 3 and March 31, 2022, submit data on your own or with the aid of a third-party intermediary, such as a Qualified Registry or Qualified Clinical Data Registry (QCDR).

To examine the listings of QCDRs and qualified registries that have received CMS approval, go to the Quality Payment Program Resource Library.