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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.

Your MIPS Final Score is calculated using data collected from the performance categories you are eligible to participate in. For rehab therapists in 2022, these categories are Quality Measures and Improvement Activities. In this article, we’ll review how your MIPS performance is measured, and how your score can impact your future Medicare reimbursement. 
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%. 

Note: For practices with 15 or fewer providers, both the Quality Measures and Improvement Activities categories are weighted at 50%. Click here to learn more about MIPS Scoring for small practices.
MIPS Category Score Formula
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.

Note: The 2022 Performance Year/2024 Payment Year will be the last year a participant can earn an exceptional performance adjustment.

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.)
Quality measures are worth up to 10 points each, but there are some factors that can reduce the number of points awarded: 
  • 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

When a MIPS participant submits their Quality Measure data, their performance is compared to a benchmark to determine how many points will be awarded for that measure. Quality Measures with a benchmark that meet the case minimum and data completeness requirements will earn participants 3-10 points, depending on their performance compared to the benchmark. Benchmarks are established using data submitted from previous reporting periods. If there is not enough data to establish a benchmark for a measure, that measure will not have a benchmark. Measures that do not have a benchmark can earn a maximum of three points
Topped-out Measures

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. 

Example Quality Measures Score Calculation
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 we earn the full 10 points for three measures, the full 7 points for 2 measures, and 3 points for your outcomes measure, for a total of 40 points. MIPS participants are required to submit 6 Quality Measures, which means there are 60 possible points to earn in this category. Let’s plug the numbers in:

(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. 

Note: For a list of the most common Improvement Activities reported by rehab therapists, click here
Example Improvement Activities Category Score Calculation  
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. 

56.67+15 = 71.76

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

In this example, let’s say you earn the full 10 points for three measures, the full 7 points for 2 measures, and 3 points for your outcomes measure, for a total of 40 points. MIPS participants are required to submit 6 Quality Measures, which means there are 60 possible points to earn in this category. Let’s plug the numbers in:

[(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

39.33 + 50 = 89.33

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. 

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