Clinicians receive Medicare reimbursement under the guidance of the Physician Fee Schedule, but can receive an additional positive incentive or negative penalty based on “performance” data. 

• MIPS is a 100-point system that consists of four weighted reporting categories: 
-Quality (30%) 
-Promoting Interoperability (25%) 
-Improvement Activities (15%) 
-Cost (30%)

• The Quality Payment Program (QPP) under CMS, determines how clinicians report performance data each year. Clinicians can submit data through an Alternative Care Organization (ACO) or via a clinical data registry to CMS. 
• NextGen HQM allows clinicians and practices to submit data files for MIPS and ACO reporting. 

The Quality Programs (QP) Team at NextGen provides guidance and assistance to help your practice achieve an optimum MIPS score and maximize Medicare reimbursement. 

More information about how NextGen supports the various methods of MIPS reporting is provided below. 

• MIPS Readiness Checklist

The quality category requires twelve (12) months of data and is weighted at 30% of the overall MIPS score.  The quality measures accommodate for differences in specialties and practices. Each quality measure can earn a decile score from 1 to 10 points. Deciles are calculated from national benchmarking data each year. A white paper is a supporting specification document for every one of the quality measures.

• Eligible Clinicians are scored on the top six (6) measures that they choose to submit.
• If a clinician or practice performs better than the national benchmark on a measure, then they will earn a higher score.
• Please review the Quality QP Factsheet and explore Workflow Workshops of commonly tracked measures.

Links to Workflow Workshops:

• Closing the Referral Loop Workflow Workshop
• Falls Screening Workflow Workshop
• Blood Pressure Measures Workflow Workshop
• Advanced Care Plan Workflow Workshop
• Medication Management Workflow Workshop
• Screening for Depression Workflow Workshop
• Diabetes Eye Exam Workflow Workshop
• Screening for Social Drivers of Health Workflow Workshop
• Urinary Incontinence Workflow Workshop
• Tobacco and Alcohol Screening Workflow Workshop

The Promoting Interoperability (PI) Category requires 6-months (180 days) of data and is weighted at 25% of the overall MIPS score. The goal of the PI category is to enhance patient engagement and electronic exchange of health information. NextGen Healthcare's certified EHR technology (CEHRT) allows your practice to be at the forefront of innovation and maintain regulatory compliance year after year. For a review of the latest updates to the PI Category, please review the PI QP Fact Sheet. You will also find many helpful resources by clicking on the PI Toolbox below.

• Receive and Reconcile Workflow Workshop
• Send Summary of Care Workflow Workshop
• Patient Electronic Access Workflow Workshop
• Query of PDMP Workflow Workshop
• CareQuality Bi-Directional HIE (coming soon)
• Security Risk Assessment (coming soon)
• High Priority SAFER Guide (coming soon)
• Direct Messaging (DM) Address for NextGen Share request form (coming soon)
• Promoting Interoperability Checklist (coming soon)

The Improvement Activity (IA) Category requires actively implementing an improvement activity for at least 90-days and is weighted at 15% of the final score. The IA category assesses your participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. You will select activities that best fit your practice and support the needs of your patients by improving patient engagement, care coordination, patient safety, and other areas of patient care. Please review the IA Inventory below.

MIPS Value Pathways (MVPs) are an alternative reporting option for MIPS eligible clinicians. Each MVP includes measures for all four MIPS categories that are more specific to a given medical specialty compared to traditional MIPS. Please review the latest MVP Overview fact sheet from the NextGen Healthcare QP Team.