American Osteopathic Association

Advancing the distinctive philosophy and practice of osteopathic medicine

Is MIPS right for you?

MIPS evaluates physicians on how they score in four areas compared to their peers.


The Merit-Based Incentive Payment System (MIPS) is an enhanced Medicare fee-for-service payment system. It combines CMS’ Meaningful Use of Electronic Health Records (MU), the Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier (VBPM), and adds a fourth new performance category for Clinical Practice Improvement Activities (CPIA).

To learn whether you should participate in MIPS this year, you can enter your national provider identifier (NPI) in the CMS MIPS Lookup Tool. MIPS affects employed physicians, too; to learn more, check out our MIPS Guide for Employed Physicians. On the flip side, if you believe you qualify for a MIPS hardship exception, learn how to apply.

CMS MIPS Lookup Tool MIPS for Employed Physicians

If you're eligible for MIPS, you must submit at least some 2017 data to avoid a 4% negative payment adjustment on 2019 Medicare Part B payments. Read more.

Available to AOA members, the MIPS Navigator™ is an online tool that allows you to easily sort through various MIPS alternatives and produce a "2017 MIPS Itinerary/Plan" designed to maximize your potential 2019 MIPS bonus. You can also use the AIR™ clinical data registry to report your MIPS measures to CMS.

Access MIPS Navigator and AIR

MIPS reporting

For 2017, CMS is allowing physicians to ease into MIPS reporting by either submitting a small amount of data, reporting for part of the year or reporting for the entire year. Physicians who participate in an advanced APM in 2017 don't need to submit MIPS data.

Physicians can report as part of a group or as individuals and will receive scores for each performance category to determine their MIPS composite performance score. Starting in 2018, small and solo practices will be able to report as part of "virtual groups" to help them hold their own in the comparison against larger practices. Your composite score will be compared to your peers’ scores, and you’ll receive bonuses or penalties based on where you fall in this comparison. 

Scoring will be based on four weighted categories:

  • Quality – 60% (based on PQRS). Clinicians can choose to report up to six measures from a range of options that accommodate differences among specialties and practices. Replaces the physician quality reporting system (PQRS).

  • Advancing Care Information– 25% (based on EHR MU Incentive Program). Choose from a menu of measures to report to. Unlike the EHR MU Incentive Program, this category won't use all-or-nothing scoring.

  • Clinical Practice Improvement Activities–15% (new category). Choose from among 90 clinical practice improvement activities to attest to, such as care coordination, beneficiary engagement, and patient safety.

2017: Flexible reporting paths

For 2017, physicians can choose from four different paths depending on their level of readiness:

  • Option 1: Test the MIPS program by submitting some data to CMS anytime in 2017. If you choose this option, you'll avoid all penalties.
  • Option 2: Partial year MIPS reporting. Submit more data for 90 or more days after Jan. 1, 2017. In this option, you'll avoid all penalties and you may qualify for a small incentive payment based on your performance.
  • Option 3: Full-year MIPS reporting. Submit full data for the full calendar year starting on Jan. 1, 2017. In this option, you'll avoid all penalties and may qualify for a modest incentive payment based on your performance.
  • Option 4: Participate in an advanced APM. For 2017, if you participate in an advanced APM, you will avoid penalties and will not need to submit MIPS data. If you receive enough of your Medicare payments or see enough of your Medicare patients through the advanced APM, you'll qualify for a 5% incentive bonus.

Virtual MIPS Reporting for 2018

Physicians who want to report for MIPS as part of a virtual group in 2018 must elect to do so by Dec. 1, 2017. Learn more in the CMS Virtual Groups Toolkit.

Virtual Groups Toolkit

MACRA exemptions

If one of these three scenarios applies to you, you're exempt:

  • It's your first year billing Medicare.
  • Your Medicare Part B revenues are $30,000 or less.
  • You care for 100 or fewer Medicare Part B patients per year.

MIPS payment

Each year, CMS will define a performance threshold based on the scores of all participating physicians and groups. If your composite performance score is above the threshold, you'll get a bonus; if it's below the threshold, you'll get a penalty. If you don't report at all, you'll get the lowest possible score. Penalties and bonuses will be capped at amounts that initially increase in the first years of the program.

  • 2019: Will depend on how you reported in 2017's flexible reporting paths (above)
  • 2020: Up to a 5% penalty; up to a 5% bonus, based on your 2018 performance
  • 2021: Up to a 7% penalty; up to a 7% bonus, based on your 2019 performance
  • 2022 and onward: Up to a 9% penalty; up to a 9% bonus, based on your 2020 (and on) performance

CMS will also set a threshold for exceptional performance, which will allow some high-performing physicians to earn an extra bonus on top of the MIPS performance bonus.

CMS videos


To view more videos from CMS on the Quality Payment Program, visit the CMS YouTube channel.


 Share This