• MIPS 2018—Bonuses and Penalties: Your 2018 MIPS Final Score Will Impact Your 2020 Medicare Reimbursement

    Written By: Rebecca Hancock, Flora Lum, MD, Chris McDonagh, Cherie McNett, Jessica Peterson, MD, MPH, and Sue Vicchrilli, COT, OCS

    This content was excerpted from EyeNet’s MIPS 2018; also see the Academy’s MIPS hub page

    Your 2018 final score (0-100 points) will impact your 2020 Medicare reimbursement. Here’s how CMS will determine whether you get a bonus or penalty.

    First, CMS Determines Your 2018 MIPS Final Score

    Your MIPS final score can range from 0 to 100 points. It is a composite score that will be based on your scores in 4 performance categories along with 2 bonus scores.

    Typically, your scores for the 4 performance categories are weighted as follows:

    In limited circumstances, CMS may recalibrate how it weights your performance category scores. This year, CMS has added new ways to opt out of reporting the promoting interoperability performance category (see Some Clinicians May Be Excused From Promoting Interoperability). If your application for a PI exception is approved, then CMS reweights your quality score so it could contribute up to 75 points to your MIPS final score, with your improvement activities score and cost score still contributing 0-15 points and 0-10 points, respectively. It would be rarer for CMS to grant you an exclusion for any of the other 3 performance categories (see Quakes, Fires, and Other Disasters!), but if it did do so, it would reweight how the remaining performance categories contribute to your MIPS final score (see Table 3: Reweighting the Performance Categories).

    Small practices get a 5-point bonus. You get this 5-point bonus if you report data for at least 1 performance category and CMS determines—based on historical data—that you are part of a small practice (see Small or Large Practice?).

    Get up to 5 bonus points for patient complexity. If you report MIPS data for at least 1 performance category, you may be eligible for a complex patient bonus.

    Second, Did You Score at Least 15 Points?

    Does your MIPS final score exceed, meet, or fall below a 15-Point performance threshold. This will determine whether your 2020 payment adjustment factor is positive, neutral, or negative (see Under the Payment Adjustment Factor, Bonuses and Penalties Will Be Budget Neutral).

    Note: During the next 4 performance years, CMS is obliged to steadily raise the performance threshold; by the 2022 performance year, the threshold will be at a level where about half of MIPS eligible clinicians may be above the threshold and about half would fall below it.

    Table 19: Payment Penalty

    If your 2018 final score is less than the 15-point performance threshold, your 2020 Medicare payments will be reduced as follows:

    • Final score larger than 3.75 points, your penalty will be based on a sliding scale as shown below.
    • Final score of 3.75 points or less, the sliding scale becomes a precipice and you receive the maximum –5% payment adjustment.

    Table 19

    Third, Did You Score at Least 70 Points?

    CMS also sees how you stack up against the 70-point additional performance threshold. If you score 70 or more points, you will get a 2020 additional payment adjustment factor, which is also known as the exceptional performance bonus (see The Additional Payment Adjustment Factor: Tap Into a $500M-Bonus Pool).


    Previous: Cost: 5 Quick Facts.

    Next: Bonuses and Penalties: Extra Points for Treating Complex Patients.

    Note: 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.

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