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Medicare's MIPS Program: Understanding the 2018 Reporting Changes


Many psychiatrists who treat Medicare patients were impacted by payment reform requirements last year and need to be aware of additional changes to the program for 2018. The American Psychiatric Association (APA) is working to provide you with the tools you need to be successful in Medicare's Merit-based Incentive Payment System (MIPS).

The 2018 changes are significant, and there is a lot of good news for APA members, including several improvements that we requested or supported. The biggest change is that more psychiatrists will be exempt from MIPS reporting under the new low-volume threshold. Full reporting is required for those who are not exempt. Small practices gained new features and advantages. The APA' qualified clinical data registry, PsychPRO, which is free to APA members, offers seamless MIPS reporting and extra points that can help you or your practice to earn a bonus.

Psychiatrists, other mental health professionals and staff can learn about the MIPS reporting requirements for 2018 in a live webinar:

Free APA Webinar:

How to Do MIPS Reporting for 2018

Wednesday, April 11
Noon to 1 p.m. EDT

Register Now

A few of the key changes are highlighted below.

Changes in Reporting Requirement Thresholds

The low-volume threshold is now set at $90,000 (in Part B charges) or 200 Medicare Part B patients, per year (up from $30,000 and 100 patients). Only MIPS eligible clinicians exceeding BOTH levels are subject to 2018 reporting requirements and 2020 payment adjustments. As a result, many physicians, physician assistants (PAs), and advanced practice registered nurses (APRNs) will not have to do MIPS reporting for 2018. Other non-physicians are expected to be added to the definition of "MIPS eligible clinicians" in 2019.

Full reporting for 2018

The "Pick Your Pace" approach (reporting only one quality measure or one improvement activity) used in 2017 has come to an end. Full reporting is required for 2018. That means reporting the following: at least six quality measures (for at least 60 percent of patients); two to four improvement activities; and several base and performance measures of the use of certified electronic health record technology (CEHRT) for the advancing care information (ACI) category. There is nothing to report for the MIPS cost category.

New options and advantages for small and solo practices

Those who join "virtual groups" can report together and be assessed together. Small practices may qualify for a special ACI hardship exception, one of seven now available. Small practices also automatically receive five points on their final MIPS score. And clinicians or practices (of any size) may receive up to five points on their final score for treating complex patients with multiple conditions or patients dually eligible for Medicare and Medicaid.

Earning MIPS bonuses

Successful reporters can earn a MIPS bonus of up to 5 percent in 2020 and exceptional performers earn an extra bonus of up to 10 percent.

APA Resources
  • APA Webinar: "How to Do MIPS Reporting for 2018"*
    April 11, 2018, noon to 1 p.m. EDT. Free to all participants. Register now
    A recorded version will be available later on the APA Learning Center at no charge to APA members and for a small fee to others.
  • APA's Payment Reform Toolkit provides the background you need to navigate this complex program. It offers additional resources, including where to go if you need individual assistance, and these detailed fact sheets:
    • Overview of Quality Payment Program
    • Take Action Now: Report for 2018 and Avoid Medicare Penalties in 2020
    • MIPS Quality Performance Category
    • MIPS Advancing Care Information Performance Category
    • MIPS Improvement Activities Performance Category
    • MIPS Cost Performance Category
    • MACRA Alternative Payment Models
  • Participating in a qualified clinical data registry, such as APA's PsychPRO, makes it easier to do MIPS reporting and can increase your chances of earning a bonus.

The APA is continuing to advocate for more improvements that will help psychiatrists succeed in the MIPS program. We’ll keep you updated with new developments as they occur, in Psychiatric News and Psych News Alerts. The next proposed rule (for 2019) should come out in July, with a final rule due by Nov. 1.

APA staff experts welcome your questions and comments to the Practice Management Helpline, 800-343-4671 or

What APA Is Doing For You
This blog post is part of an occasional series highlighting how APA advocates on your behalf to support the profession of psychiatry and put our interests before key policymakers.

* The American Psychiatric Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The APA designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Post by Anita Everett, M.D.

Anita Everett, M.D. is the President of APA. Read Dr. Everett's full biography.

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