MIPS Scoring Methodology
Legal Disclaimer: Statements contained in this training are WebPT’s interpretation of the QPP rules. The information contained in this training is provided on an “as is” basis with no guarantees of accuracy, completeness, or timeliness and without warranty of any kind, express or implied. The information provided in this training is general in nature and should not be considered legal, consulting, or professional advice. QPP Participants should consult with professional advisors and/or the Center for Medicare and Medicaid Services for advice concerning specific information about QPP.
IN THIS ARTICLE
|
MIPS Final Score
Your MIPS Final Score is a combination of the points earned in the Quality Measures and Improvement Activities performance categories. These categories are weighted, with Quality Measures accounting for 85% of the total MIPS score and Improvement Activities accounting for 15%.
The formula below is used to calculate a MIPS Category Score.
(Points Earned/Total Points Possible in Category) x Category Weight x 100 = Category Points Earned
MIPS Final Score
Quality Measures Category Points Earned + Improvement Activities Category Points Earned = MIPS Final Score
MIPS Final Scores are used by Medicare to determine what payment adjustments will be for the payment year that corresponds with the performance period. Currently, we are in the 2022 performance period, meaning your MIPS Score this year will affect your payments from Medicare in 2024. The chart below shows how your MIPS Final Score will impact your future Medicare payment.
Maximize Your Quality Measures Category Score
MIPS participants must submit data for at least six Quality Measures—one of which must be an outcome measure. Quality Measures are worth up to 10 points each, so participants can earn up to 60 points before the category is weighted. Your Quality Measures Category Score is worth 85% of your Final MIPS Score.
To obtain the maximum amount of points for each measure, your data must reflect the following:
- The case minimum has been met, which means the measure has been reported on 20 or more patients
- The measure has been reported on at least 70% of all eligible patients, regardless of insurance payer
- You have met the reporting rate for the measure, meaning you’ve performed the recommended clinical quality action at least once per measure, and documented the results. (For example, Measure 128 focuses on collecting BMI data. The clinical quality action is documenting the BMI data, and a follow-up plan if the patient’s BMI is outside of the expected range.)
- The submitted measure doesn’t have 20 cases
- The submitted measure was not reported on 70% of all eligible patients
- The measure does not have a benchmark
- Poor performance compared to the benchmark
- The submitted measure does not have supporting documentation to indicate that a quality action was performed, or why the quality action could not be performed.
- The submitted measure is “Topped-out”
MIPS Measure Benchmarks
Topped-out Measures, according to Medicare, are measures where meaningful distinctions and improvement in performance can no longer be made. In other words, a good score for these measures is too easily attainable. Medicare awards fewer points to topped-out measures to incentivize participants to choose measures where performance improvement is more likely.
Deciding Which Measures to Report
Use the chart below to help determine which measures give you the best chance to maximize your Quality Measures Category Score.
Remember, MIPS participants must submit data for six Quality Measures. If you collect data for more than six measures, your best six will be sent. Choosing to collect data for more than six measures gives you more options to ensure that you’ve scored as many points as you can for the Quality Measures category.
Recall the MIPS Category Score Equation:
(Points Earned/Total Points Possible in Category) x Category Weight x 100 = Category Points Earned
(40/60) x 0.85 x 100 = 56.67 Points Earned
Maximize Your Improvement Activities Score
The Improvement Activities category evaluates the ways in which clinicians and groups work to improve their practice as a whole over an extended period of time (e.g., by enhancing care coordination, expanding patient access to care, and improving patient-clinician decision-making). With 40 available points, this category is weighted at 15% of the total MIPS score.
There are over 100 available Improvement Activities to report on, with high-weighted activities being worth 20 points, and medium-weighted activities being worth 10. You can choose whichever activities you prefer to get to the 40 available points. Improvement Activities can only be reported once per performance period, and each activity must be performed for at least 90 continuous days during the performance period to be considered eligible for attestation.
Recall the MIPS Category Score Equation:
(Points Earned/Total Points Possible in Category) x Category Weight x 100 = Category Points Earned
In this example, let’s say you submit the attestation for 1 high-weighted Improvement Activity, and two medium-weighted, for a total of 40 points, out of a possible 40.
(40/40) x 0.15 x 100 = 15 Points Earned
Example Final Score Calculation
Now that we’ve calculated our score for Quality Measures and Improvement Activities, let’s add them up and see what the Final MIPS Score is.
MIPS Final Score
Quality Measures Category Points Earned + Improvement Activities Category Points Earned = MIPS Final Score
In the Quality Measures category, we earned 56.67 points. In Improvement Activities, we earned 11.25.
With a MIPS final score of 71.76, we can expect to receive a negative payment adjustment in 2024, as this score falls below the score required for a neutral or positive adjustment.
MIPS Scoring Methodology for Small Practices (15 or fewer providers)
Starting in 2022, practices with 15 or fewer providers will have both the Quality Measures and Improvement Activities categories reweighted to 50%. Additionally, small practices will receive 6 bonus points in the Quality Measures category, and they will earn double the points for each Improvement Activity submitted. This means small practices need to attest to half as many improvement activities.
With this knowledge, the above guide will still help you maximize your MIPS score, but the MIPS Category Score formula is a little different. Let’s calculate the MIPS final score for a small practice.
MIPS Category Score (Small Practices)
[(Points Earned/Total Points Possible in Category) x Category Weight (0.50) x 100] + 6 = Category Points Earned
Quality Measures
[(40/60) x 0.50 x 100] +6 = 39.33
Improvement Activities
In this example, let’s say you submit the attestation for 1 high-weighted Improvement Activity, worth a total of 40 points, out of a possible 40. Let’s plug the numbers in:
[(40/40) x .5 x 100] = 50
MIPS Final Score (Small Practices)
Quality Measures Category Points Earned + Improvement Activities Category Points Earned = MIPS Final Score
With a MIPS Final Score of 89.33, we can expect to receive a positive payment adjustment in 2024, with the possibility of being awarded an exceptional performance bonus!
Still have MIPS questions? Click here for our MIPS FAQ.