Under MIPS, when is payment based on performance evaluated?

Under the Merit-based Incentive Payment System (MIPS), payment adjustments based on performance are evaluated using data from one year prior to the performance year. This system means that providers are assessed on how well they perform during a specific calendar year, and those evaluations influence their payment in the following year.

For example, if a provider's performance is assessed in 2022, the results of that evaluation will determine the payment adjustments for 2023. This retrospective assessment allows practices to identify areas for improvement and optimize their performance before the evaluations impact their reimbursements. The structure encourages a continuous cycle of evaluation and improvement in the quality of care provided.

The rationale behind using the previous year’s data is to provide a buffer period, allowing practices time to adjust and implement necessary changes in response to performance data without immediate penalties.