• MIPS 2018—What’s New: Your Final Score Got More Complicated

    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 MIPS final score is a composite score. In 2017, it was based on your scores for 3 performance categories; this year, CMS will factor in up to 4 performance category scores and up to 2 new bonus scores.

    Your MIPS final score (0-100 points) will mostly be based on 4 performance category scores. For each performance category, you get a score of 0%-100%, and its contribution to your final score is weighted (e.g., quality’s weight is 50% of the final score, meaning it can contribute up to 50 points). The 4 scores would typically be weighted as follows:

    There are 2 new bonus scores:

    Your MIPS final score is capped at 100 points.

    In 2018, there are more opportunities to be excused from ACI. For example, you can apply for a significant hardship exception if you are in a small practice or if your electronic health record (EHR) system gets decertified (see Some Clinicians May Be Excused From Promoting Interoperability).

    Like last year, CMS is expected to start accepting hardship applications in August; it will stop accepting applications after Dec. 31, 2018.

    If your application is approved, promoting interoperabilityI’s contribution to your final score is reduced to 0, and quality’s weight is increased to compensate (see Table 1: 2018 MIPS Final Score).

    In extreme and uncontrollable circumstances, you can apply to have any performance category reweighted. Read Quakes, Fires, and Other Disasters!

    Bonuses and Penalties Are Starting to Increase

    Your MIPS final score in 2017 impacts your 2019 payments; your 2018 final score impacts your 2020 payments. 

    You need to score more points to avoid the penalty. In 2017, if your final score was below a 3-point performance threshold, your 2019 payments will be penalized; in 2018, the performance threshold to avoid a penalty has increased to 15 points (see Table 19: Payment Penalty).

    The maximum penalty has increased. In 2017, a final score of 0 points would result in a –4% payment adjustment in 2019. In 2018, a final score of 3.75 points or less will result in a –5% payment adjustment in 2020.

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    Next: What's New: Low-Volume Threshold Went Up; Practice Size Is Now Based on Historic Data.

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