MIPS proposed rule: Measures, eligibility and more will affect your practice

Why This Topic Matters

The proposed changes could alter how practices report performance, determine eligibility, and prepare for audits or documentation review. Understanding the scope of the rule helps practices evaluate workflow, vendor readiness, and reporting strategy before the performance period begins.

Article Sections

1. MIPS round-up

   An overview of the proposed rule and the major MIPS topics highlighted in the article. This section frames the reporting and eligibility issues discussed later.

2. Reporting thresholds and eligibility

   Coverage of who is included in MIPS, which clinicians may be excluded, and how reporting thresholds differ by submission method. The section also addresses non-patient-facing clinicians and telehealth considerations at a high level.

3. Submission methods for individuals and groups

   A summary of the reporting channels available to individual clinicians and groups, including CMS options for performance categories. This section also notes vendor readiness and platform-related considerations.

4. Quality program alignment and validation

   Discussion of CMS efforts to align quality programs and the proposed validation and audit process for quality reporting. The section explains that CMS intends to review reporting completeness and compliance.

5. Changes to measures, specialty sets, and cross-cutting measures

   An overview of proposed changes to the quality measure inventory, specialty-related measure sets, and cross-cutting measures. The section also covers the broader implications for practices that previously relied on older reporting structures.

6. Group reporting through the CMS web interface

   Information about group participation via the CMS web interface and the related eligibility considerations. The section explains that groups must have patients eligible for the interface measures.