Updated November 2023. Note: 2023 changes are indicated in red.

This page presents an overview of the quality category for the 2023 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 30% 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 IRIS^® Registry Preparation Kit (updated annually), 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 six measures, CMS will count the highest-scoring outcome measure toward your quality score, and then the five highest-scoring remaining measures.

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. For process measures, this means that the median performance rate is  95% or higher (non-inverse measures) or  is 5% or lower (inverse measure). A non-process measure is considered topped out if the level of variance is less than 0.10 and the 75^th and 90^th percentiles are within 2 standard errors. 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. 

Note on Measures in Their First or Second Year in the MIPS Program: Beginning in 2022, measures in their first year in MIPS will have a 7-point floor. Measures in their second year in MIPS will have a 5-point floor. Both of these scoring floors assume that the data completeness requirement has been met.  

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.
• There 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 70% of denominator-eligible patients will receive 0 points.

How to Get Your Points

CMS has some pointers on how to collect your points. See this CMS chart to review your progress.

Quality Category Bonuses

All quality category bonuses Except the small practice bonus and the improvement bonus have been removed beginning in 2022.

• 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.
    • This bonus isn’t available to small practices that receive a quality performance category score from facility-based measurement.

Improvement Scoring

• Individual MIPS eligible clinicians, groups, virtual groups, and APM Entities may earn up to 10 additional percentage points based on your improvement in the quality performance category from the previous year.
  
  
• Improvement scoring isn’t available for clinicians who are scored under facility-based measurement in either or both performance periods,

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:

• The Academy’s IRIS^® Registry
• Claims (small practices only) OR
• Your EHR vendor

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.