Embrace the MIPS Additional Payment Adjustment for Exceptional Performance

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Embrace the MIPS Additional Payment Adjustment for Exceptional Performance

This article discusses the Additional Positive Payment Adjustment for exceptional performance under MIPS. The article requires membership to AHIMA however for reprints please reach out to us at info@apollohit.com

in summary, the article discusses the $500 million fund available annually for the first six years of the MIPS program. These funds are used to reward high performing clinicians with additional positive payment adjustments that can reach as high as 10%.  In 2017 practices that reach 70 or more MIPS points are eligible for this additional payment adjustment. Practices that score near 100 points may be eligible for of up to a 10% positive payment adjustment in addition to the baseline positive payment adjustment.

Because Medicare artificially establish the performance threshold for MIPS at three points there will be relatively little funds available from practices that receive negative payment adjustments to fun positive payment adjustments. It is estimated that a near perfect score under MIPS will not result in more than a 1 to 2% positive payment adjustment from the base score. This makes the additional payment adjustment the most likely way practices can earn significant returns on investment for MIPS based on performance in 2017 and 2018.

Practices that achieve a MIPS score of 85 points in 2017 may see a positive payment adjustment of between 5% and 6% for all part B payments in 2019.

Practices and large healthcare organizations should take the additional payment adjustment for exceptional performance into strong consideration when determining their MIPS strategy and goals.

This article was authored by Michael Marron-Stearns, MD, CPC, CFPC, the CEO and founder of Apollo HIT, LLC.  For reprints of this article please reach out to us at info@apollohit.com.

Article citation:
Marron-Stearns, Michael. “Embrace the MIPS Additional Payment Adjustment for Exceptional Performance” Journal of AHIMA 88, no.6 (June 2017): 30-33.


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