MIPS 2018—Improvement Activities: How You’ll Be Scored

This content was excerpted from EyeNet’s MIPS 2018; also see the Academy’s MIPS hub page. 

In 2018, maxing out the improvement activities performance category will be enough to avoid a 2020 payment penalty. To do so, you will need to successfully perform 1 to 4 performance activities—the amount depends on how those activities are weighted, as well as the size and location of your practice.

However many you do, they should all be done during the same performance period, which must be at least 90 consecutive days.

Your score for improvement activities contributes up to 15 points to your 2018 MIPS final score.

How You’ll Be Scored

How many points do you get for an improvement activity? This depends on (1) how the activity is weighted and (2) whether you’re able to double the score.

If an activity’s weight is:

• medium—it scores 10 points (double score is 20 points)
• high—it scores 20 points (double score is 40 points)

Who scores double? MIPS participants can score double for an improvement activity if they are:

• in a small practice (fewer than 16 eligible clinicians, based on historical data),
• in a rural practice (as defined by CMS),
• in a practice that is in a geographic health professional shortage area (HPSA), or
• non–patient-facing MIPS clinicians.

Are you a non–patient-facing clinician? Probably not. To be one, you would have to bill Medicare for no more than 100 patient-facing encounter codes—including Medicare telehealth services—in a designated period. For group (or virtual group) reporting, if more than 75% of the NPIs who bill under the group’s TIN (or virtual group’s identifier) during the determination period are non–patient-facing, then the ensemble as a whole is considered non–patient-facing.

Has CMS determined that you are in a small practice, in a rural practice, or in a geographic HPSA? Find out by checking the CMS MIPS Participation Look-Up Tool. Enter your 10-digit National Provider Identifier (NPI) to access your record, and then scroll down to “Other Factors,” which is where those categories will be listed if any of them apply to you. If you are in more than 1 practice, make sure you scroll down through your whole record so you can see your status at each practice. (Don't know your NPI? Look it up here.)

Maximum score is capped at 40 points. If you don’t score double, you can accrue the maximum score of 40 points by performing either:

• 2 high-weighted activities (2 × 20 points),
• 2 medium-weighted activities (2 × 10 points) and 1 high-weighted activity (1× 20 points), or
• 4 medium-weighted activities (4 × 10 points)

If you are eligible to score double, you can accrue 40 points by performing:

• 1 high-weighted activity (1 × 40 points) or
• 2 medium-weighted activities (2 × 20 points).

Each improvement activity is all or nothing. You won’t score points for an improvement activity unless it is performed for 90 consecutive days and you satisfy all of its requirements. You do not score partial credit for reporting a partially performed activity.

Some MIPS participants will automatically get credit. MIPS eligible clinicians (and groups) who are practicing as part of an accredited patient-centered medical home (or comparable specialty practice) will automatically score 40 points (the maximum score); those who are participating as part of an advanced alternative payment model (APM) will automatically score a minimum of 20 points (half the maximum score). Few ophthalmologists are expected to fall within these 2 categories in 2018.

Your improvement activities score (0-40) points is turned into a percentage, which contributes up to 15 points to your MIPS final score. CMS divides your total number of points by 40 and turns the resulting fraction into a percentage (e.g., a score of 20 points would be 50%). This contributes up to 15 points to your MIPS final score (e.g., a score of 50% would contribute 7.5 points).

___________________________

Previous: PI:The Promoting Interoperability Measure Set.

Next: Improvement Activities: Decide How You Will Report Improvement Activities.

Note: Meeting regulatory requirements is a complicated process involving continually changing rules and the application of judgment to factual situations. The Academy does not guarantee or warrant that regulators and public or private payers will agree with the Academy’s information or recommendations. The Academy shall not be liable to you or any other party to any extent whatsoever for errors in, or omissions from, any such information provided by the Academy, its employees, agents, or representatives.

COPYRIGHT© 2018, American Academy of Ophthalmology, Inc.® All rights reserved. No part of this publication may be reproduced without written permission from the publisher. American Academy of Ophthalmic Executives® and IRIS® Registry are trademarks of the American Academy of Ophthalmology®.