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Traditional MIPS Overview

What

Traditional MIPS, established in the first year of the Quality Payment Program, is the original reporting option available to

MIPS eligible clinicians
 for collecting and reporting data to MIPS. Your performance is measured across 4 areas – quality, improvement activities, Promoting Interoperability, and cost.   

There are also 2 other reporting options available to MIPS eligible clinicians for meeting MIPS reporting requirements:


How it Works

You submit the quality and Promoting Interoperability measures and improvement activities that you collect/perform during the 

performance year
. We collect and calculate cost measures for you. The 4 performance categories are scored and make up your MIPS final score. Your final score determines the
payment adjustment
 applied to your Medicare Part B claims. These categories are:

Quality

Quality Illustration Traditional MIPS

This performance category assesses the quality of the care you deliver, based on performance measures created by CMS, as well as medical professional groups, specialty societies and interested parties. You pick the quality measures that best fit your practice.

Learn more about quality requirements for traditional MIPS.

Promoting Interoperability

PI Illustration Traditional MIPS

This performance category promotes patient engagement and the electronic exchange of health information using 

certified electronic health record technology
 (CEHRT). You report a defined set of Promoting Interoperability objectives and measures. 

Learn more about Promoting Interoperability requirements.

IA Illustration MIPS Traditional

Improvement Activities

This performance category assesses how you improve your care processes, enhance patient engagement in care, and increase access to care. You choose the activities appropriate to your practice. 

Learn more about improvement activities requirements for traditional MIPS.

Cost Illustration - MIPS

Cost

This performance category assesses the cost of the patient care you provide. We calculate cost measures, based on your Medicare claims, to determine the cost of the care you provide to certain patients. 

Learn more about cost requirements for traditional MIPS.


Why

MIPS was designed to tie payments to quality and cost-efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care.


When

The MIPS performance year begins on January 1 and ends on December 31 each year. If you’re eligible for MIPS, you must report data collected during the calendar year by March 31 of the following calendar year. Payment adjustments, based on the data you submit for services provided, are applied to Medicare Part B claims during January 1 to December 31 of the year following data submission. For example, if you collect data between January 1 and December 31, 2024 (i.e., the performance year), you must report your data by March 31, 2025, and you'll receive a MIPS payment adjustment between January 1 and December 31, 2026 (i.e., the payment year). 

Learn more about the Timelines and Important Deadlines.

Choose How You Will Participate

It’s possible to participate, collect, and report your data to MIPS in multiple ways. When reporting traditional MIPS, you can participate as an individual, group, virtual group or APM Entity. If you’re required to participate in MIPS, you’ll receive a payment adjustment based on the data you submit or don’t submit.

Group

A practice can choose to collect and report aggregated data at the group level on behalf of all its clinicians. The clinicians in the practice that are MIPS eligible at the group level will receive a payment adjustment based on the group’s final score. The clinicians in the practice that are MIPS eligible at the individual level will receive a payment adjustment based on the group’s final score unless they have a higher final score from individual or APM Entity participation. 

Learn more about group participation.

Individual

Clinicians can collect and report data representing their individual performance. Clinicians that are MIPS eligible at the individual level will receive a payment adjustment based on their individual final score unless they have a higher final score from group or APM Entity participation. (Note: If you’re MIPS eligible at the individual level, then you’re required to participate in MIPS, either as an individual, group, virtual group or APM Entity.)

Learn more about individual participation.

Virtual Group

Clinicians can elect to form a virtual group. CMS-approved virtual groups collect and report aggregated data on behalf of all their clinicians. The MIPS eligible clinicians in the virtual group will receive a payment adjustment based on the virtual group’s final score, even if they voluntarily participate as an individual, group or APM Entity. 

Learn more about virtual group participation.

APM Entity

An APM Entity can choose to collect and report aggregated data at the Entity level on behalf of its MIPS eligible clinicians. (Promoting Interoperability data can still be reported at the individual or group level when reporting quality and improvement activities at the Entity level.) The clinicians in the APM Entity that are MIPS eligible at the individual or group level will receive a payment adjustment based on the APM Entity’s final score unless they have a higher final score from individual or group participation. (Note that clinicians in a virtual group always receive the virtual group's final score.)

Learn more about APM Entity participation.