MIPS FAQ
MIPS Compliance FAQ
1. What is MIPS and why does it matter to my practice?
MIPS (Merit-based Incentive Payment System) is a CMS-driven quality payment program that affects your Medicare Part B reimbursement. Your annual MIPS performance score can lead to bonus incentives or significant penalties (up to 9%) based on how well you meet key performance measures.
TriumpHealth helps ensure you stay compliant and profitable by managing your full MIPS lifecycle, from eligibility analysis to audit support.
2. Is my practice required to participate in MIPS?
You’re typically required to report under MIPS if you bill more than:
- $90,000 in Medicare Part B allowed charges, and
- Provide care to 200+ Medicare beneficiaries, and
- Deliver 200+ covered professional services
TriumpHealth performs a MIPS eligibility analysis to confirm whether individual clinicians or groups must participate, and if any exemptions or opt-in pathways apply.
3. What categories does MIPS measure and how are they scored?
MIPS includes four performance categories:
- Quality (30%)
- Promoting Interoperability (PI) (25%)
- Improvement Activities (IA) (15%)
- Cost (30%) – scored automatically by CMS
TriumpHealth guides your team on selecting appropriate Quality Measures, validating PI attestation, identifying IA opportunities, and tracking performance in real time.
4. What is the Security Risk Assessment (SRA) and why is it critical for MIPS?
The SRA is a required component of the Promoting Interoperability (PI) category. Without a valid, annually updated SRA, your PI score can be invalidated, putting your entire MIPS submission at risk.
TriumpHealth provides comprehensive HIPAA-compliant SRAs with mitigation plans, ensuring you maintain compliance and score optimally in the PI category.
5. What support does TriumpHealth offer for MIPS reporting and compliance?
We provide end-to-end MIPS consulting services, including:
- Eligibility verification and exemption evaluation
- Measure selection & scoring strategy
- Real-time performance tracking dashboards
- Promoting Interoperability validation
- Improvement Activities implementation
- SRA documentation and remediation planning
- Audit preparation & targeted review assistance
- Final data submission to CMS
Our tailored support ensures you maximize your MIPS score while minimizing penalties and administrative burden.
6. How can I avoid MIPS penalties and maximize my bonus?
Penalties apply automatically to non-compliant providers and can grow to -9% of Medicare Part B reimbursements. To avoid penalties and earn bonuses, TriumpHealth helps you:
- Report proactively across all categories
- Choose high-performing, specialty-specific measures
- Stay current with CMS rule changes
- Submit data early and error-free
- Maintain annual SRA compliance
7. Does TriumpHealth help if we’ve already missed a reporting deadline or received a low score?
Yes. We assist with:
- Targeted Review submissions to contest an unfair or incorrect score
- Corrective action planning for future performance years
- Rebuilding trust with CMS by reestablishing compliance quickly
8. How does TriumpHealth’s approach differ from a generic EHR or MIPS vendor?
Most EHR vendors only offer basic MIPS tools. TriumpHealth goes far beyond by providing:
- Specialty-specific consulting
- Dedicated MIPS experts who understand regulatory nuances
- Integrated compliance services including SRA and HIPAA alignment
- A personalized compliance plan for your practice
- Ongoing performance monitoring and reporting throughout the year
9. What specialties or practice sizes do you work with?
TriumpHealth supports a broad spectrum of MIPS-eligible clinicians and organizations, including:
- Solo practitioners and small practices
- Group practices and large multi-specialty groups
- Health systems and accountable care organizations (ACOs)
- Primary care physicians and surgical specialists, including general surgery, orthopedics, ENT, ophthalmology
- Anesthesiologists and pain management providers
- Radiologists, pathologists, and diagnostic testing centers
- Nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists
- Behavioral health providers (e.g., psychiatrists, clinical psychologists, LCSWs, NPs in mental health)
- Physical, occupational, and speech therapists
- Chiropractors and podiatrists
- Hospitalists, Skilled Nursing Facilities (SNFs) and Long-Term Care (LTC) providers
- Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), when billing under their individual NPIs for Part B services
Our MIPS strategies are custom-tailored to the specific specialty, scope of services, and reporting structure, whether you’re reporting as an individual, a group, or via a virtual group.
10. When should I start working on MIPS for the performance year?
Immediately. MIPS is a year-long program. The earlier you start, the more strategic and impactful your performance improvement can be.
TriumpHealth recommends initiating your MIPS planning in the first quarter to avoid last-minute scrambling and underperformance.
11. How do I get started with TriumpHealth’s MIPS Consulting?
You can schedule a free consultation with our MIPS specialists to assess your eligibility, scoring potential, and compliance gaps. You can always contact us via email [email protected] or call us at (888) 747-3836
Learn more: TriumpHealth MIPS Consulting Services
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