The Merit-Based Incentive Payment System Navigator™

Medicare is changing the way it pays physicians and most other healthcare professionals. Depending on their performance in 2018 on Quality, Improvement Activities use of certified health information technology and Cost, these clinicians will receive an adjustment to their fee schedule payments in 2020 that may range from a penalty of 5% to a bonus of up to 25%. 2020 bonuses will not be that large). Over the next several years, this impact will increase dramatically. By 2022 (2020 performance year), the fee schedule adjustments will range from -9% to as much as +37%! In addition to the fee schedule impact, your performance will be published on the public Physician Compare website.


Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to eliminate the “Sustainable Growth Rate” (SGR) and replace it with the “Merit-Based Incentive Payment System (MIPS).” Congress enacted MIPS to move Medicare from paying for volume to paying for value. MIPS is intended to promote the Triple Aim – better health, higher quality and lower cost.

Unfortunately, MIPS is extremely complex. From the standpoint of individual clinicians and their practices, there are numerous exceptions and alternatives, and the application and impact of those exceptions and alternatives will vary widely depending on practice demographics, specialty and current or proposed involvement in various Alternative Payment Models (APMs), among other things.

Because the 2018 performance period starts January 1, clinicians and their practice administrators need to plan now. Using the MIPS Navigator™ is an alternative to trying to decipher hundreds of pages of dense regulations.

The MIPS Navigator™ is an on-line tool that makes it possible for individual clinicians or practice administrators to quickly and easily sort through the various MIPS alternatives and produce a “2018 MIPS Itinerary/Plan” designed to maximize their potential 2020 MIPS bonus.

By answering a few questions specific to your practice, the MIPS Navigator™ will let you determine:

  1. Whether you or your practice will likely be subject to MIPS at all
  2. What the likely impact of various MIPS payment adjustments will mean to your practice in 2020
  3. Whether you should participate in an APM and the potential impact of that choice

Assuming you will likely be subject to MIPS, the MIPS Navigator™ will produce:

  1. a succinct summary of the specific things you need to consider to maximize your MIPS score in each of the 4 MIPS domains that will likely apply to your practice;
  2. a final 2018 MIPS Itinerary/Plan, based on your choices

Within the MIPS Navigator™ tool are hyperlinks you will find that can provide additional information on particular topics. The hyperlinks are identified by blue underlined text.

Finally, the MIPS Navigator™ licensees will have access to the tool for the full year. Your work is stored, so you can work on your MIPS Itinerary/Plan over time. You will also be able to create an amended plan should you reconsider and decide some changes may help increase your score.