Qualifying a Patient for MIPS

To ensure you satisfy MIPS requirements, you will need to evaluate and qualify every patient Episode of Care, commonly referred to as a Case, for MIPS eligibility. This is required for all Episodes of Care, regardless of payer.

For each individual patient Episode of Care, you will need to evaluate if the Classification or region of injury is one of the qualifying measures. If the individual is being treated for a qualifying measure, ensure the Episode of Care is properly Qualified or Disqualified.

Click a link below to jump to the corresponding section: 

Qualifying an Episode of Care for MIPS

Disqualifying an Episode of Care from MIPS

Classification is not an Approved Region of Injury

Qualifying an Episode of Care for MIPS

Eligible Episodes of Care that qualify for MIPS are treating a classification covered by a MIPS PRO.
*Denotes a field required for Risk-Adjustment

    1. Click Patients in the upper navigation bar
    2. Select the patient from the Patient menu
    3. Navigate to the desired Episode of Care episode_of_care_for_mips_article.png
    4. Click the Edit icon next to the selected Episode of Care episode_of_care_edit.png
    5. Using the drop-down menu, select the correct Supervising Provider and Insurance Type* edit_episode_of_care_provider_and_insurance.png
    6. Toggle the MIPS Qualification button to indicate if this Episode of Care is Qualified  edit_episode_of_care_mips_toggle.png
    7. Complete the fields for the Primary Classification 
      1. From the Treatment Category* drop-down, select the corresponding classification for one of the approved measures. select_treatment_category.png
      2. You have the option to then add qualifiers. Qualifiers will vary based on the Treatment Category selected. qualifiers.png
      3. Finally, you can include the Injury Onset / Surgery Date* and the Duration of Symptoms.*injury_onset_and_duration_1.png

    1. If the Episode of Care falls within the Disqualification criteria: 

  • Toggle the MIPS Qualification to DisqualifiedScreen_Shot_2021-02-18_at_9.54.39_AM.png

2.  Click Save 


Classification is not an Approved Region of Injury

If the patient is being treated for a region other than an approved Classification for patient-reported outcomes, you will use "Other" to exclude the patient Episode of Care from MIPS. 

1. In the set of Primary Classification fields, select "Other" under Treatment Category.

  • By selecting "Other" as the Classification this is reporting that the patient is being treated for something other than the approved measures and will be excluded from the MIPS registry. 


2. Click Save 

More information on the qualifications in this article review MIPS Infographic.