MIPS 2019—Bonuses and Penalties: How CMS Calculates Your MIPS Final Score

This content was excerpted from EyeNet’s MIPS 2019; also see the Academy’s MIPS hub page. 

Your MIPS final score can range from 0 to 100 points. It is based on your scores in up to four performance categories (plus a bonus score), which are typically weighted as follows:

• quality is weighted at 45% of your MIPS final score,
• promoting interoperability (PI) is weighted at 25%,
• improvement activities is weighted at 15%, and
• cost is weighted at 15%.

What do the weights mean? The weights indicate how many points each performance category can contribute to the maximum 100-point MIPS final score. For example, quality’s default weight is 45% of your MIPS final score, which means that it can contribute up to 45 points. So if your quality score is 60%, it would contribute 27 points (60% of 45 points) to your MIPS final score.

In limited circumstances, CMS may recalibrate how it weights your performance category scores. For example, if CMS excuses you from reporting the PI performance category, it will decrease PI’s weight from 25% to 0% and increase quality’s weight from 45% to 70%. So a quality score of 50% would now contribute 35 points (50% of 70 points) to your MIPS final score.

Similarly, if CMS is unable to score you on any of the cost measures, it will reduce cost’s weight to 0% and add 15% to quality’s weight.

CMS might also reweight performance category scores if you are disrupted by “extreme and uncontrollable” circumstances.

Get up to 5 bonus points for patient complexity. If you report MIPS data for at least one performance category, you may be eligible for a complex patient bonus. CMS determines this bonus based on two indicators: 1) the average Hierarchical Condition Category (HCC) risk score of your patients; and 2) a “dual eligible” score, which is based on the proportion of beneficiaries eligible for both Medicare and Medicaid

Your MIPS final score. Your MIPS final score, which is capped at 100 points, is the sum of your weighted performance category scores (0-100 points) plus your complex patient bonus (0-5 points).

Example: How CMS Determines Your MIPS Final Score

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