Since the passing of MACRA in 2015, CMS is required by law to maintain a quality payment incentive program. This program, known as the Quality Payment Program, breaks down into two plans: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).
Under MIPS specifically, clinicians are weighed against four performance categories to produce a final score. This score is used to calculate the eventual payment adjustment, which determines the final reimbursement rate for a claim. The four scoring categories in MIPS are:
- Quality performance
- Promoting Interoperability (PI)
- Improvement Activities
- Care Cost