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  • MIPS 2023—Your MIPS Final Score

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

    Your 2023 MIPS final score determines how CMS will adjust payments for your Medicare Part B services in 2025, as discussed in “Your 2025 MIPS Payment Adjustment.”

    Understand MIPS scoring. Read this section to learn how the MIPS performance category scores are factored into your MIPS final score. Next, ascertain which performance categories you think you'll be scored on and review the relevant sections of this supplement to see how each of those are scored.  

    How CMS Calculates Your MIPS Final Score 

    Your MIPS final score can range from 0 to 100 points. It is based on your weighted scores in up to four performance categories and can be topped up with the complex patient bonus, which is discussed below.

    You are scored on up to four performance categories. CMS will try to assign you scores for each of the following performance categories:

    How your performance category scores are weighted. The default weights of your performance category scores are as follows:

    • quality’s weight—30%
    • promoting interoperability’s weight—25%
    • improvement activities’ weight—15%
    • cost’s weight—30%

    What the weights mean. If your quality score’s weight is 30%, it can contribute up to 30 points to your MIPS final score. For example, a quality score of 50% would contribute 15 points (50% of 30 points).

    Get up to 10 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.

    Will you get a complex patient bonus? You will be eligi­ble for the complex patient bonus only if you have at least a median score for the HCC risk indicator and/or for the dual eligible indicator.

    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 (0-10 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:

    • quality score of 60% contributes 18 points (60% of 30 points)
    • promoting interoperability score of 80% contributes 20 points (80% of 25 points)
    • improvement activities score of 100% contributes 15 points (100% of 15 points)
    • cost score of 60% contributes 18 points (60% of 30 points)

    If the clinician’s complex patient bonus contributes 2 bonus points, then the MIPS final score would be 73 points (the sum of 18 + 20 + 15 + 18 + 2).

    Previous: Your 2025 MIPS Payment Adjustment 
    Next: Reweighting the Performance Categories

    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.


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