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MIPS is the first large scale value-based payment model to impact PTs.

The three types of participation are described below.

For PTs who are eligible but not required to participate, participation will be a business decision in which they must weigh the benefits of earning incentives with the risk for penalties. APTA has created resources to help PTs navigate this program. 

Navigate MIPS options

Mandatory Participation

PTs in private practice who exceed all 3 criteria of the low-volume threshold (annually receive more than $90,000 in Medicare part B payments AND provide care for more than 200 Part B-enrolled Medicare beneficiaries AND bill more than 200 professional services), must participate in MIPS, subject to the payment adjustment of +/-9%. Nonparticipation will result in the full 9% penalty.

Opt-in Participation

Individual PTs: PTs in private practice who exceed 1 or 2 of the low-volume threshold criteria (annually receive more than $90,000 in Medicare part B payments OR provide care for more than 200 Part B-enrolled Medicare beneficiaries OR bill more than 200 professional services), will be eligible to opt in to MIPS, subject to the payment adjustment of +/-9%. 

Groups: If a practice collectively exceeds 1, 2, or all 3 of the low-volume threshold criteria it can opt-in to MIPS as a group, subject to the payment adjustment of +/-9%.

Voluntary Participation

PTs who don't meet the low-volume threshold and choose not to opt in to participation will be able to report MIPS data voluntarily without being subject to the payment adjustment.


Additional Merit-Based Incentive Payment System Content

APTA's Outcomes Registry Again Receives Key CMS Designation

Jan 19, 2021 / News

The APTA Physical Therapy Outcomes Registry has been approved as a qualified clinical data registry — an important benefit for PTs in MIPS.

MIPS Data Collection Mechanisms

Dec 22, 2020 / Resource

APTA provides details for the different MIPS data collection reporting mechanisms.

Final MIPS Rule Contains Minimal Changes

Dec 8, 2020 / Review

Like the proposed version, the final rule from CMS keeps the Quality Payment Program mostly as-is.

Selecting a Vendor for MIPS

Apr 23, 2020 / Article

CMS: Minimal Changes to MIPS, Advanced Alternative Payment Models for 2021

Aug 7, 2020 / Review

The Quality Payment Program would see mostly minor changes and some shifts to respond to COVID-19-related challenges.

MIPS Performance Scores Now Available

Aug 7, 2020 / News

CMS has released its MIPS scores for your 2019 performance, which could affect your payment in 2021.

CMS Offers MIPS Reporting Relief

Jun 29, 2020 / News

The "Extreme and Uncontrollable Circumstances" exception could allow clinicians to have MIPS performance categories reweighted.

MIPS Data Collection Sheets - 2020

Jun 13, 2020 / Resource

Access data collections sheets for claims-based MIPS reporting for 2020.

MIPS Is Here

Apr 1, 2019 / Column

This is what you need to know now.

Everything you need to know about the Quality Payment Program, Including MIPS

Dec 5, 2018 / Article

This course provides insights into the New Year based on moving to value-based payment. Recorded webinar. Free to members.