• 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:

    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

    In this example, the default weights of the performance categories apply.

    Performance Category

    Performance Category Score

    Maximum Points Under Default Weighting

    Point Calculation

    Points

    Quality

    50%

    45 points

    60% of 45 points =

    27 points

    Promoting interoperability

    80%

    25 points

    80% of 25 points =

    20 points

    Improvement activities

    100%

    15 points

    100% of 15 points =

    15 points 

    Cost

    60%

    15 points

    60% of 15 points =

    9 points

    Complex patient bonus

    2 points

    2019 MIPS final score

    73 points

    Previous: Cost: The Medicare Spending Per Beneficiary Measure

    Next: Bonuses and Penalties: How CMS Determines Your Payment Adjustment

    DISCLAIMER AND LIMITATION OF LIABILITY: 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.

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