Skip to main content
  • MIPS 2023—Quality: How CMS Calculates Your Quality Score

    This content is excerpted from EyeNet’s MIPS 2023: A Primer and Reference; also see the Academy’s MIPS hub page.

    This can be described as a four-step process.

    1. CMS calculates your achievement points total: CMS determines your total mea­sure achievement points, which is the sum of your achieve­ment points for up to six quality measures that you reported plus—if applicable—your score for the HWR measure (see “The HWR Measure for Large Practices”).

    2. CMS determines your numerator: CMS calculates your numerator, which is your total measure achievement points plus your total measure bonus points plus—if you are in a small practice that submits data on at least one quality measure—a 6-point small practice bonus.

    3. CMS determines your denominator: CMS calculates your denominator, also known as your total available measure achievement points, which—assuming that you had at least six quality measures available to report—is 60 (or 70 if the HWR measure applies). In limited circumstances, CMS may determine that you have fewer than six quality measures to report and can reduce that denominator accordingly. If, for example, you report a measure that has been suppressed, CMS would reduce your denominator by 10.

    4. CMS does the math: CMS divides your numerator by your denominator, turns the resulting fraction into a per­centage, and then your improvement percent score is added.

    The resulting percentage is your quality performance category per­cent score, which is capped at 100%. Unless your performance categories are reweighted (see “Reweighting the Performance Categories”), it contributes up to 30 points to your MIPS final score. For example, if your quality score is 60%, it would contribute 18 points (60% of 30 points).

    Previous: Quality Scoring: You Can Earn an Improvement Percent Score
    Next: ICD-10 Turbulence and Changes in Clinical Guidelines

    DISCLAIMER AND LIMITATION OF LIABILITY: All information provided by the American Academy of Ophthalmology, its employees, agents, or representatives participating in the Academy’s efforts to explain regulatory and reimbursement issues is as current and reliable as reasonably possible. The Academy does not provide legal or accounting services or advice. You should seek legal and/or accounting advice if appropriate to your situation.

    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 either 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© 2023, 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 Ophthalmology ®, American Academy of Ophthalmic Executives®, IRIS®, the Focus logo, and Protecting Sight. Empowering Lives ®, among other marks, are trademarks of the American Academy of Ophthalmology®.

    All of the American Academy of Ophthalmology-developed quality measures are  copyrighted by the AAO’s H. Dunbar Hoskins Jr., MD, Center for Quality Eye Care (see terms of use).