• Quality Reporting in the Merit-Based Incentive Payment System

  • Updated January 2021. Note, 2021 changes are indicated in red.

    This page presents an overview of the quality category for the 2021 performance year. You can also get more specific information on measures and reporting.

    Under the Merit-Based Incentive Payment System, the Centers for Medicare and Medicaid Services evaluates providers on four categories, one of which is the quality category.

    • The quality category is worth 40 45 percent of the MIPS final score.
    • The quality category is scored on performance points, up to a total of 60 points.
    • The quality category has a full calendar year performance period.

    Need help with MIPS reporting? Use the Academy’s 2021 IRIS® Registry Preparation Kit, a detailed user guide that assists with your IRIS Registry utilization for quality improvement and MIPS reporting (free downloadable PDF or for purchase print-on-demand spiral notebook).

    How CMS Measures Quality

    Each clinician or group’s quality is measured based on 6 self-selected quality measures, one of which must be an outcome measure.

    How CMS Scores Quality

    If you submit more than 6 measures, CMS will count the highest-scoring outcome measure toward your quality score, and then the five highest-scoring remaining measures. Any additional measures can be counted toward quality bonuses if they meet certain criteria.

    If you do not submit an outcome measure, CMS will only score 5 measures, regardless of how many you submit. This means that the highest quality category score you would be able to achieve is 50 out of 60 possible points.

    When the same measure is submitted more than one way, such as claims and IRIS Registry, the one with the greatest number of measure achievement points will be selected for scoring.

    Note on Topped-Out Measures: Some measures are topped-out. This means that the average performance rate is greater than 95%. Measures that are topped out typically have benchmarks that "stall" for one or more deciles. Measures that have been topped out for two or more years will have a 7-point cap; this means that even a perfect performance will yield a top score of 7 out of 10 points for the measure.

    Note on "Stalled" Measures: Not all measures that have benchmarks that have "stalled" are topped out. A measure that has "stalled" benchmarks will have performance rates listed for the first several deciles but will have no performance rates listed for any following decile until the top decile. 

    Practice size determines how CMS scores each individual quality measure. The number of eligible clinicians in your practice determines practice size. Eligible clinicians include MD, DO, OD, PA NP and CRNA

    Practices of 1-15 clinicians (Small Practices)

    • Each measure reported on at least one patient will score 3 points
    • To earn more than 3 points, you must report for a full calendar year on at least 70% of denominator-eligible patients.
    • This must also be a denominator of more than 20 patients.
    • Submission via claims is available for small practices only. Small practice clinicians can report via claims for either group or individual MIPS participation.
    • A 6-point bonus will be applied to your numerator for this category if measures are reported.

    Practices of >15 Clinicians

    • Each measure reported on at least 70% of all denominator-eligible patients, and a total of more than 20 patients will be scored on performance.
    • Each measure reported on at least 70% of all denominator-eligible patients, but fewer than 20 patients total, will receive 3 points.
    • Each measure that is not reported on at least of denominator-eligible patients will receive 0 points.
      Data Completeness Met
    (at least&nbsp70% of all denominator-eligible patients)
    Data Completeness Not Met

    Case Minimum Met
    (at least 20 patients)

    3+ points based on performance

    • 0 points for practices with >15 ECs
    • 3 points for small practices (≤15 ECs)
    Case Minimum Not Met 3 points
    • 0 points for practices with >15 ECs
    • 3 points for small practices (≤15 ECs)

    Quality Category Bonuses

    • Outcome and High Priority (Up to 6 bonus points for the category in total)
      • Each additional outcome measure after the requirement earns 2 bonus points.
      • Each additional high-weighted measure earns 1 bonus point.
      • To receive bonus points, you must report the submitted measures:
        • On a minimum of 70% of denominator-eligible patients; and
        • With a denominator > 20 patients; and
        • A performance > zero.
    • End-to-End Electronic Reporting using 2015 CEHRT (Up to 6 bonus points for the category)
      • 1 point per measure
      • Available through IRIS Registry-EHR Integration
    • Small practice bonus
      • 6 point quality category bonus for those in small practices that report data on at least one quality measure.

    Quality measures category is topped at 60 points regardless of how many bonus points are awarded.

    Submission Options

    Claims submission is only available for small practices, with reporting options as individual or group. 

    Practices can complete all quality reporting through any of the following:

    Note: Individual measures including eCQMs, MIPS CQMs, QCDR measures, and for small practices, claims, can be submitted through multiple collection types, to meet the minimum requirement.