This content is excerpted from EyeNet’s MIPS 2021; also see the Academy’s MIPS hub page.
Scoring for this performance category is the same as in 2020. To max out your score, you will need to successfully perform one to four performance activities—the amount that you need to perform depends on how those activities are weighted, as well as the size and location of your practice (see “Who scores double?” below).
You typically need to perform each activity for at least 90 consecutive days.
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 have one of these special statuses:
- small practice (fewer than 16 eligible clinicians; see “Small or Large Practice?”),
- rural practice (zip codes will be considered rural based on the most recent Federal Office of Rural Health Policy data files on eligible zip codes, not the HRSA Area Health Resource File dataset as CMS had incorrectly stated prior to the 2020 performance year),
- 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. Few ophthalmologists are likely to fall within this category. You are designated a non–patient-facing MIPS clinician if you bill Medicare for no more than 100 patient-facing encounter codes—including Medicare telehealth services—in a designated period.
Check whether CMS doubles your score. To see if you fall within one of the special status categories, use the CMS Participation Status tool. (See “What’s Your MIPS Participation Status?”.)
Maximum score is capped at 40 points. If you don’t have a special status that doubles your score, you can accrue the maximum score of 40 points by performing either:
- two high-weighted activities (2 × 20 points)
- two medium-weighted activities (2 × 10 points) and one high-weighted activity (1 × 20 points), or
- four medium-weighted activities (4 × 10 points).
If you are eligible to score double, you can accrue 40 points by performing:
- one high-weighted activity (1 × 40 points) or
- two 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 the required time—typically a minimum of 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 two categories in 2021.
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 40 points would be 100%). This contributes up to 15 points to your MIPS final score (e.g., a score of 100% would contribute 15 points).
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Next: How to Report Activities
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