This content is excerpted from EyeNet’s MIPS 2020; also see the Academy’s MIPS hub page.
Your 2020 MIPS final score (0-100 points) is a composite score. As in past years, your MIPS final score will be based on your weighted scores in up to four performance categories:
What the weights mean. If your quality score is weighted at 45%, it can contribute a maximum of 45 points to your MIPS final score; for example, a quality score of 50% would contribute 22.5 points (50% of 45 points).
In limited circumstances, CMS can reweight the performance categories. The reweighting scenarios that have most typically applied to ophthalmologists are as follows:
- Promoting interoperability reweighted to zero. If you qualify for a promoting interoperability exception, CMS can reduce the weight of that performance category to zero and increase quality’s weight from 45% to 70%. A quality score of 50% would now contribute 35 points (50% of 70 points) to your MIPS final score.
- Cost reweighted to zero. If you don’t meet the case minimum for all cost measures, CMS will not factor cost into your MIPS final score. Instead, it will reduce cost’s weight from 15% to zero and increase quality’s weight from 45% to 60%. A quality score of 50% would now contribute 30 points (50% of 60 points) to your MIPS final score.
- What if both cost and promoting interoperability are reweighted to zero? Your quality score would now have a weight of 85%, meaning that a quality score of 50% would contribute 42.5 points (50% of 85 points) to your MIPS final score.
- Emergencies. CMS can reweight performance categories if it determines that “extreme and uncontrollable circumstances” apply.
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.
Calculating your MIPS final score. Your MIPS final score is the sum of your weighted performance category scores (0-100 points) plus your complex patient bonus (0-5 points). It is capped at 100 points,
Example. In this hypothetical example, a clinician scores 60% for quality, 80% for promoting interoperability, 100% for improvement activities, and 60% for cost. If the default weights of those four performance category scores apply, then they would contribute to her MIPS final score as follows:
- quality score of 60% contributed 27 points (60% of 45 points)
- promoting interoperability score of 80% contributed 20 points (80% of 25 points)
- improvement activities score of 100% contributed 15 points (100% of 15 points)
- cost score of 60% contributed 9 points (60% of 15 points)
If her complex patient score contributes 2 bonus points, then her MIPS final score would be 73 points (the sum of 27 + 20 + 15 + 9 + 2).
Special scoring for clinicians who join a practice late in the year. If you join a practice in the last three months of 2020, CMS will assume that you won’t have enough measures available to you to participate as an individual in MIPS at that practice. What does this mean for your score at that practice? If you join a newly formed practice (established after Oct. 1, 2020) or if you join an established practice where the clinicians are reporting as individuals, CMS will award you a MIPS final score of 45 points, which is this year’s performance threshold, meaning that you would get a neutral payment adjustment in 2022. But if you join an established practice that is reporting as a group and includes your National Provider Identifier in its group-level reporting, you would get its group score; your data after you join should be included in its group reporting.
Previous: Succeed at MIPS
Next: Reweighting the Performance Categories
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.
COPYRIGHT© 2020, 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, among other marks, are trademarks of the American Academy of Ophthalmology®.