Doctor holding tablet background. Text in front says MIPS 2020.

Keeping Up with The Changes: Understanding MIPS 2020

It is incredibly important that your practice is keeping up with the changes that have taken place in regard to the Merit-based Incentive Payment System (MIPS) in 2020. Keep reading to understand MIPS and what has changed for the 2020 final rule for the Quality Payment Program.

What is The Quality Payment Program?

According to CMS, The QPP is a program that ‚Äúimproves Medicare by helping you focus on care quality and the one thing that matters most —- making patients healthier.‚Äù It is the best effort of CMS to transition patient care from fee for service model to value-based care. There are two pathways for clinicians to choose through the quality payment program, MIPS and the Advanced Alternative Payment Models (APMs).

What is the Merit-Based Incentive Payment System?

MIPS is the process of scoring a provider’s performance called MVPs or MIPS Value Pathways. The MVPs include the eligible clinicians’ quality, improvement activities, cost of services, and the promotion of interoperability. It was a component of the Quality Payment Program (QPP) that was established by the Centers for Medicare & Medicaid Services in 2015.

Providers are responsible for reaching the performance thresholds set in place by CMS in order to earn the highest reimbursement rate possible.

Breaking MVPs Down:

  • Quality: This category for performance ranks the quality of care a provider delivers based on key performance indicators put in place by CMS.
  • Interoperability: Through the implementation of a Certified Electronic Health Record (CEHR), this category promotes the interoperability/electronic exchange of patient health information between treating clinicians or the patient.
  • Improvement Measures: The category measures the steps clinicians are taking to improve care at their practice, promote patient engagement, and improve access to care tools.
  • Cost: Based on your Medicare claims, CMS calculates the cost of the services you should be provided to patients.

What is Different in MIPS 2020?


While category weights for MIPS 2020 are staying the same, other aspects of the scoring process are shifting. The performance threshold, for example, was set at 30 points to avoid penalty. In 2020, that performance threshold is now set to 45. The additional performance threshold has also increased to 85 points for MIPS 2020, which is the number of points necessary to earn added reimbursements. This number was set at 75 in 2019.

Payment Adjustments:

CMS has written the payment adjustments for MIPS 2020 according to the MACRA statute requirements and is set at +/-9%. In MIPS 2019, this payment adjustment was set at +/- 7%. Their projected MIPS positive payment adjustments from 2020 to closer to 6.25%.

Category Requirements:

The three biggest changes that CMS has made to category requirements in MIPS 2020 are as follows.

  • CMS removed 42 measures.
  • They increased the data completeness requirements
  • They added specialty measure sets.

In order to maximize your reimbursements through the Quality Payment Program, providers need to make improvements in their MIPS Value Pathways. To learn more about how to optimize your reimbursements, click here.



Related Blog Articles