MIPS Scoring

MIPS stands for Merit based Incentive Payment System. MIPS annually scores eligible Medicare Part B clinicians on a 100-point performance scale which results in a Composite Performance Score (CPS). The payment adjustment will be based on this Composite Performance Score which is calculated by the measures and categories reported. MIPS is designed to be a budget-neutral program, but there is $500 million allocated to provide additional incentive to exceptional performers- those earning 85 or more points in 2021. Essentially, this means that the better you do as a Medicare provider, the more extra revenue that you can gain.

At the beginning of each year, data must be collected and that will be the effective measurement for the next 12 months (i.e. January 1st – December 31st).

MIPS Scoring is broken down into four categories:

  • Quality (40% of score)
  • Promoting Interoperability (25% of score)
  • Improvement Activities (15% of score)
  • Cost (20% of score)

 

Quality

Quality measures how well you are caring for your patient. This can be through Patient Safety, Efficiency, Patient Experience, or Care Coordination. There are six measures that you have to look at in order to quantify your quality of care. Those can be found here.

Promoting Interoperability

Promoting Interoperability (PI) promotes patient engagement and electronic exchange of information using certified electronic health record technology (CEHRT). There are 10 measures associated with this category and you can learn more about them here.

Improvement Activities

Improvement Activities (IA) focuses on rewarding clinicians for delivering care that emphasizes care coordination, beneficiary engagement, and patient safety.

Cost

Cost is focused on your performance on the patient with their budget. Were you able to create a care plan that decreased their costs? This can only be assessed at the end of the year (i.e. Cost for 2020 can only be looked at in 2021).

For more information on MIPS Scores, please refer to these sources*:

https://qpp.cms.gov/mips/quality-requirements

https://mdinteractive.com/MIPS#What%20is%20MIPS?

https://www.practicefusion.com/quality-payment-program/what-is-mips/

 

*MIPS Scoring is updated yearly, with changes in their requirements. When looking at the requirements to submit a MIPS form, remember to look at the established year.