TriumpHealth MIPS Compliance Consulting Solutions

Our team can guide you through the complex requirements of this program and help you maximize your reimbursements by achieving high performance scores.

Understand What is the Merit Based Incentive Payment System (MIPS) with TriumpHealth

The Merit-based Incentive Payment System (MIPS) is a program designed to promote high-quality, efficient healthcare by incentivizing providers based on performance. Navigating MIPS requirements can be complex, but with TriumpHealth’s MIPS Compliance Consulting Services, you can ensure your practice not only meets all necessary criteria, but also is set-up to potentially receive incentives from CMS.

How does MIPS work?

Traditional MIPS, which started in the first year of the Quality Payment Program, is the first way for MIPS eligible clinicians to collect and report data to MIPS. It measures how well you do in 4 areas: quality, improvement activities, promoting interoperability, and cost.

What are MIPS reporting options? Are you required to report?

Clinicians who are required to report for MIPS will need to submit certain performance measures related to quality, promoting interoperability and improvement activities. Based on their performance, eligible clinicians will receive a negative or positive payment adjustment to their Medicare reimbursements. As rules and regulations are being continually updated and changed it becomes very burdensome for a practice or healthcare organization to stay abreast with the ever-changing requirements.

Who has to report MIPS?

According to the Centers for Medicare and Medicaid Services (CMS), clinicians who are eligible to report MIPS include:

  • Physicians (MD/DO)
  • Dentists (DDS/DMD)
  • Nurse Practitioners (NP)
  • Physician Assistants (PA)
  • Clinical Nurse Specialists (CNS)
  • Certified Registered Nurse Anesthetists (CRNA)

Additionally, physical or occupational therapists, speech-language pathologists, audiologists, clinical psychologists, certified nurse-midwives, and registered dietitians or nutrition professionals may also be required to participate in MIPS if they meet certain eligibility criteria.

It is important for all clinicians to understand if they are required to report MIPS and what is expected of them in order to avoid penalties and potentially earn bonuses.

CMS provides a tool on their website called the QPP Participation Status Lookup Tool, which allows clinicians to check their participation status for each performance year. Clinicians can also contact their Medicare Administrative Contractor (MAC) for more information on their specific MIPS reporting requirements.

What are the criteria for participating in MIPS?

To be eligible to participate in MIPS, clinicians must meet certain criteria set by CMS:

  • Have an active National Provider Identifier (NPI)
  • Bill Medicare Part B
  • Exceed at least one of the following thresholds:
    • $90,000 in Medicare Part B allowed charges for covered professional services
    • Provide care for more than 200 Medicare patients
    • Provide at least 200 covered services
  • If a clinician meets all of these criteria, they are considered eligible to participate in MIPS and must report data on their performance measures to CMS. However, there are certain exemptions and special circumstances that may apply to some clinicians. It is important for clinicians to review their specific eligibility requirements with CMS or their MAC.

How is MIPS data reported?

MIPS data can be reported in various ways, including through qualified registry, electronic health record (EHR) vendor, or directly to CMS. Clinicians must report data for a full calendar year by the deadline set by CMS each year.

CMS provides a list of approved MIPS Registry vendors and EHR vendors on their website. These vendors have been vetted and are considered reliable for reporting MIPS data accurately and securely.

Clinicians should carefully review the reporting requirements and options available to them in order to determine the best method for reporting their MIPS data. It is also important to stay updated on any changes or updates made by CMS to reporting requirements.

Are any providers exempt from MIPS? What are the exclusions from MIPS?

Yes, there are certain providers who may be exempt from participating in MIPS. These include:

  • Newly enrolled Medicare providers (less than one year)
  • Providers significantly participating in an Advanced Alternative Payment Model (APM)
  • Providers with low-volume thresholds (less than $90,000 in Medicare Part B allowed charges., provide less than 200 covered services or fewer than 200 Medicare patients)
  • Hospital-based clinicians

These exemptions are based on the type of practice and level of participation in alternative payment models. CMS determines these exemptions each year and updates them as needed. It is important for clinicians to review their specific eligibility requirements with CMS or their MAC in order to determine if they are exempt from MIPS reporting.  Overall, these exemptions help ensure that only eligible clinicians who meet certain criteria are required to participate in MIPS and report data on their performance measures. This is meant to make the program more manageable for providers and allow them to focus on providing quality care to patients without additional regulatory burdens.

MIPS Eligibility and Participation Options

The MIPS program has three reporting options for eligible clinicians:

  1. Individual Reporting: Eligible clinicians can report as individuals and have their performance measured based on their individual data.
  2. Group Reporting: Eligible clinicians can join with other practitioners in a group practice to report MIPS data collectively as a group.
  3. Virtual Group Reporting: This option allows solo practitioners or groups of up to 10 eligible clinicians to form “virtual groups” and participate in MIPS together.

Each reporting option has its own set of rules, requirements and benefits. It is important for eligible clinicians to carefully consider which option is best suited for their practice before making a decision.

How can participating in MIPS benefit a clinician?

Participating in MIPS can bring several benefits for clinicians, including:

  • Avoiding penalties: Eligible clinicians who do not participate or fail to meet reporting requirements may face penalties through negative payment adjustments. By actively participating and reporting MIPS data, clinicians can avoid these penalties.
  • Potentially earning bonuses: Eligible clinicians who successfully report MIPS data may be eligible to earn positive payment adjustments as a reward for their efforts in improving healthcare quality.
  • Improving healthcare quality: The goal of the Quality Payment Program is to improve the overall quality of healthcare by promoting value-based care. By participating in MIPS and accurately reporting data, clinicians can contribute to this effort and ultimately provide better care for patients.
  • Staying ahead in the industry: As value-based care continues to grow, participation in programs like MIPS can help clinicians stay up-to-date with industry trends and demonstrate their commitment to providing high-quality care.

Overall, participating in MIPS can bring several benefits for clinicians and ultimately contribute to the improvement of healthcare quality.  By meeting reporting requirements and actively engaging in improving healthcare value, clinicians can position themselves as leaders in the industry and provide better care for their patients.  It is important for eligible clinicians to understand their participation status and reporting requirements in order to take advantage of these potential benefits.

What is the MIPS 2024 threshold?

The performance threshold represents the minimum score that an eligible clinician must achieve to avoid a negative payment adjustment. In MIPS 2024, this threshold continues to stay at 75 points, just like 2023. However, CMS has proposed to raise the passing threshold to 82, though they do not have an exact date for that change.

This potential increase reflects CMS’s efforts to continuously raise the bar for quality and cost performance in healthcare. It also means that clinicians will need to put more effort into meeting these higher thresholds to avoid penalties.

How do I get started reporting MIPS?

Speak to our MIPS Consultants here at TriumpHealth to learn more about the MIPS program.

Our Comprehensive MIPS Solutions

TriumpHealth offers tailored MIPS consulting solutions to streamline your compliance process, integrating seamlessly with your existing EHR systems. Our solutions are designed to enhance healthcare technology implementation, focusing on improving practice efficiency and patient outcomes.

Key Features:

  • Expert Guidance: Our consultants provide in-depth knowledge and practical advice to help you meet MIPS performance thresholds.
  • Customizable EHR Solutions: Integration with your existing EHR system ensures a smooth transition and ongoing support.
  • Data Analytics: Advanced analytics to track and improve your MIPS scores continuously.
  • Dedicated Support: Ongoing assistance to address any challenges and ensure compliance.


Frequently Asked Questions

What is MIPS (Merit-based Incentive Payment System) compliance, and why is it important for healthcare providers participating in value-based care programs?

MIPS (Merit-based Incentive Payment System) compliance is adherence to the regulations and requirements outlined by the Centers for Medicare & Medicaid Services (CMS) for healthcare providers participating in value-based care programs. It is important because MIPS participation impacts reimbursement and incentives for providers, as well as their reputation and standing in the healthcare industry.

What are the key components and requirements of MIPS, and how do they impact the reimbursement and incentives received by healthcare providers?

Key components of MIPS include Quality, Promoting Interoperability, Improvement Activities, and Cost categories. Providers must meet specific requirements and report data in each category to receive a MIPS score, which ultimately determines their reimbursement adjustments and potential incentives. MIPS impacts a provider by linking Medicare reimbursements to their performance. High performance leads to positive payment adjustments, while low performance can result in penalties.

How do TriumpHealth consultants help healthcare providers stay compliant with MIPS?

TriumpHealth provides expert consulting to assess your current MIPS performance and  provide recommendations for improving MIPS performance and quality of care, such as optimizing electronic health record (EHR) systems, clinical workflow documentation, collecting book of evidence for MIPS audit preparation and reporting, and providing training for clinical and administrative staff members.

Can TriumpHealth integrate with my current EHR system?

Yes, TriumpHealth’s solutions are designed to integrate seamlessly with your existing EHR system, ensuring a smooth transition and ongoing support. Currently our TriumpHealth consultants work with over 40 different EHR systems.

What makes TriumpHealth different from other MIPS consulting services?

TriumpHealth combines advanced healthcare technology with expert consulting to provide a comprehensive, tailored approach to MIPS compliance, focusing on improving practice efficiency and patient outcomes. Our consultants stay updated on changes in regulations and requirements through ongoing education, participation in industry events, and close monitoring of CMS updates. Our consultants help healthcare providers adapt to evolving program guidelines by providing timely information, training on proposed MIPS rules, and support in implementing necessary changes to ensure compliance and maximize performance scores.

Can providers participate in MIPS as an individual provider or a group practice?

Yes, providers can participate in the Merit-based Incentive Payment System (MIPS) either as an individual provider or as part of a group practice. When participating as an individual, a provider is assessed based on their own performance and data. If participating as a group, all eligible clinicians within the practice are assessed collectively, and the group’s combined performance data is used to determine MIPS scores and subsequent payment adjustments.

What impact does MIPS have on my Medicare payments and clinical reputation?

Participating in MIPS has a direct impact on both Medicare payments and clinical reputation. The MIPS program is designed to incentivize high-quality care by providing positive payment adjustments for providers who meet or exceed performance criteria. These adjustments can range from 0.5% to 9% of Medicare payments, depending on the provider’s MIPS score.

In addition to financial incentives, the MIPS program also allows patients to access performance data for individual providers and group practices through various public reporting mechanisms. This means that a provider’s MIPS scores and overall performance can potentially affect their clinical reputation and patient satisfaction.

What is the minimum amount of MIPS data I have to report to avoid a penalty?

As a participant in the MIPS program, it is important to understand that reporting any amount of data will help you avoid a negative payment adjustment. This means that even if you are only able to report on one quality measure or one improvement activity, it can still make a difference in avoiding a penalty.

However, it is recommended that you report as much data as possible in order to maximize your chances of receiving a positive payment adjustment and potentially earning bonus points. The more measures and activities you report on, the higher your final score will be, and the more likely you are to receive a positive adjustment.

Get Started with TriumpHealth Today

Ready to optimize your MIPS performance and streamline your practice’s operations? Partner with TriumpHealth and leverage our expertise in MIPS compliance. Contact us at (888) 747-3836 X0 or by emailing to learn more about our MIPS Consulting solutions and take the first step towards enhanced performance and maximized reimbursements.

Our Process


Assessment and Eligibility Determination

Conduct a comprehensive assessment of the medical practice’s eligibility for the Merit-Based Incentive Payment System (MIPS), considering factors such as practice size, specialty, and patient population.


Performance Analysis

Evaluate the practice’s current performance in relevant MIPS categories (Quality, Promoting Interoperability, Improvement Activities, and Cost), identifying areas for improvement and optimization to maximize MIPS scores and potential incentives.

Implementation of MIPS Strategies: Develop and implement customized strategies tailored to the practice’s specific needs and goals, including workflow optimization, EHR optimization, quality measure selection, and performance tracking mechanisms.


Reporting and Compliance

Ensure accurate and timely reporting of MIPS data to relevant reporting mechanisms (e.g., Quality Payment Program website), providing ongoing support and guidance to ensure compliance with MIPS requirements and maximize performance outcomes.

Benefits of Working with TriumpHealth

MIPS Compliance Consulting


Risk Reduction

Minimize the risk of reduced reimbursements by adhering to MIPS regulations through our expert advice.


Revenue Maximization

With a higher MIPS score, unlock the potential for increased Medicare reimbursement and bonus opportunities.


Improved Patient Outcomes

We utilize MIPS data to help you improve clinical practices, resulting in better patient care.


Seamless Compliance

Ease the burden of regulatory compliance with our end-to-end MIPS support.

Maximize Your Revenue. Schedule a Consultation Today!

We will help you achieve financial and regulatory compliance goals resulting in improved patient outcomes and increased revenue.