This content is excerpted from EyeNet’s MIPS 2021; also see the Academy’s MIPS hub page.
Your 2021 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. Their default weights are as follows:
What the weights mean. If your quality score is weighted at 40%, it can contribute a maximum of 40 points to your MIPS final score; for example, a quality score of 60% would contribute 24 points (60% of 40 points). In some circumstances, CMS can reweight the performance categories' contributions to your MIPS final score.
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 the complex patient bonus based on two indicators:
- the average Hierarchical Condition Category (HCC) risk score of your patients; and
- a “dual eligible” score, which is based on the proportion of beneficiaries eligible for both Medicare and Medicaid.
Note: For the 2020 performance year, because of the COVID-19 pandemic, CMS increased the maximum complex patient bonus from 5 points to 10 points. What about this year? At time of press, the agency was indicating that it would cap this bonus at the usual 5 points for the 2021 performance year.
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 a 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:
If the clinician’s complex patient bonus contributes 2 bonus points, then the MIPS final score would be 73 points (the sum of 24 + 20 + 15 + 12 + 2).
Next: Reweighting the Performance Categories
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