• 2018 MIPS Step-by-Step Guides

     

    Below are step-by-step guides on calculating, collecting and reporting each MIPS performance category: Quality (50 final MIPS points), Promoting Interoperability (PI) previously Advancing Care Information (ACI) (PI, 25 final MIPS points), and Clinical Practice Improvement Activities (CPIA, 15 final MIPS points). Please note there is a fourth category “Cost” which practices will be scored on (10 final MIPS points), but does not require data submission and is scored through claims submitted to Medicare.

    A maximum of a 100 final MIPS score can be earned by achieving the full points in each category.

     2018 MIPS Overall Points

    Practices may choose to submit one category or a combination of categories to receive enough points to avoid a 5% penalty to their Medicare Part B Fee Schedule in 2020. For 2018 the minimum final MIPS score amount must be greater than or equal to 15 MIPS points to avoid the penalty. Any MIPS score achieved that is over 15 points could potentially provide an incentive payment.

    For more information about the MIPS program and steps to take on getting started please review our MIPS page

     

    QUALITY Step-by-Step Guide (link to PDF)

    QUALITY Point Calculation

    The Quality category accounts for 50 final MIPS points out of the possible 100 final MIPS score. This category requires a year’s worth of data (Jan. 1 to Dec. 31, 2018) on 6 selected measures. Each measure is worth up to 10 points (allowing for 60 category points total) and depending on performance physicians/practices will receive between 1 and 10 points per measure. Below is an example* of how this category would be scored: 

    Dr. Smith reported on 6 quality measures. On three of her measures she received the full 10 measure points, but on the other three she was only able to achieve 5 measure points each.

    (10 points x 3 measures) + (5 points x 3 measures) = 45 category points
    45 category points ÷ 60 category points possible = .75 or 75%

    Because Dr. Smith achieved 75% of her category points, she can apply 75% of the 50 final MIPS Quality points available to her final MIPS score:

    50 final MIPS Quality points x .75 or 75% = 37.5 final MIPS points.
    Dr. Smith’s FINAL MIPS Quality score is 37.5 points, which will be counted towards her final MIPS score. This point total is more than the 15 MIPS points benchmark, therefore Dr. Smith will avoid a 5% penalty on her 2020 Medicare payments even if she chooses to only participate in the Quality category. Additionally, Dr. Smith could potentially receive an incentive payment for achieving > 15 MIPS points.

    *This example does not consider any possible bonus points practices could achieve such as the small practice bonus and others offered within MIPS.
    2018 Quality Point Example

     

    PI (previously ACI) Step-by-Step Guide (link to PDF)

    PI Point Calculation

    The PI category accounts for 25 final MIPS points out of the possible 100 final MIPS score. This category requires a performance period of at least 90 consecutive days within 2018. 

    In 2018, as in 2017, there will still be 2 measure set options to report. The option you’ll use to send in data is based on your Certified EHR Technology (CEHRT) edition. 

    • PI Objectives and Measures - 2015 CEHRT or combination of 2014 & 2015 CEHRT
    • PI Transition Objectives and Measures - 2014 CEHRT, 2015 CEHRT, or combination of both

    Each of these measure sets is made up of three scored sections. These sections add up to a total 165 category points, but physicians/practices cannot earn more than 100 points in this category as it is capped at 100: 

    • Base Score - the base score makes up 50 of the possible 165 PI category points and is the only REQUIRED portion of this category. Physicians/practices must successfully submit each measure in the base score to receive any of the 25 final MIPS score points for the PI category.
    • Performance Score - the performance score makes up 90 of the possible 165 points in the PI category. These are made up of additional measures beyond the base score measures that can be reported to receive the remainder of the points available within the PI category. Performance score points can only be achieved after the base score measures have been completed.
    • Bonus Score - the bonus score makes up 10 of the possible 165 points in the PI category. Please review page 9 of the PI Fact Sheet for ways to earn a bonus score.

    The performance score and bonus score are added to the base score to get the total Promoting Interoperability performance category score: 

    PI Points

    The total Promoting Interoperability performance category score will then be multiplied by the 25 final MIPS PI points available. This product is then added to the overall MIPS final score. For example:

    Dr. Smith’s EHR is 2014 CEHRT with no 2015 CEHRT capabilities. Therefore she will need to select the PI Transition Objectives and Measures set.

    After completing her measure set Dr. Smith receives a full base score of 50 category points (by completing all four of her base score measures).

    In addition to her base score she receives 40 performance score points and no bonus score points.

    (50 base score points + 40 performance score points + 0 bonus score points) = 90 PI category points
    90 category points ÷ 100 category points possible* = .9 or 90%

     *We use 100 category points possible for this calculation rather than the total possible of 165 because this category is capped at 100 points.

    Because Dr. Smith achieved 90% of her category points, she can apply 90% of the 25 final MIPS PI points available to her final MIPS score: 
    25 final MIPS PI points x .90 or 90% = 22.5 final MIPS points

    Dr. Smith’s FINAL MIPS PI score is 22.5 points, which will be counted towards her final MIPS score. This point total is more than the 15 MIPS points benchmark, therefore Dr. Smith will avoid a 5% penalty on her 2020 Medicare payments even if she chooses to only participate in the PI category. Additionally, Dr. Smith could potentially receive an incentive payment for achieving > 15 MIPS points.

    2018 ACI Point Example

     

    CPIA Step-by-Step Guide (link to PDF)

    CPIA Point Calculation

    The CPIA category accounts for 15 final MIPS points out of the possible 100 final MIPS score. This category requires each activity selected to be implemented within your practice for at least 90 consecutive days during 2018.

    This category is attestation based, meaning when it is time to report only a “yes” or “no” statement is required for each activity completed. No documentation is required to be submitted, but be sure to keep record of the activity completion in case of audit by CMS. Due to the simplicity of this category, it is recommended that practices seeking to simply avoid the Medicare penalty (and nothing more) do so by completing the CPIA category. Completing the CPIA category will provide you with a full 15 points and avoid the 5% penalty in 2020.

    There are two levels of activities “medium” weighted or “high” weighted activities. Small practices (15 clinicians or fewer) are required to complete 1 high weighted activity (each worth 40 category points) or 2 medium weighted activities (each worth 20 category points) to achieve a full 40 out of 40 category points resulting in receiving the full 15 final MIPS points towards their final MIPS score. Below is an example:

    Dr. Smith works in a practice of 10 clinicians. The practice has selected 2 medium weighted activities to complete for 2018 (activities completed by a practice can be attested to by an individual or group).

    (1 medium activity x 20 points) + (1 medium activity x 20 points) = 40 category points
    40 category points ÷ 40 category points possible = 1 or 100%

    Because Dr. Smith (and her practice) achieved 100% of her category points, she can apply 100% of the 15 final MIPS CPIA points available to her final MIPS score:

    15 final MIPS CPIA points available x 1 = 15 points

    Dr. Smith’s FINAL MIPS CPIA score is 15 points, which will be counted towards her final MIPS score. This point total meets the 15 MIPS points benchmark; therefore Dr. Smith will avoid a 5% penalty on her 2020 Medicare payments even if she chooses to only participate in the CPIA category.

    2018 CPIA Point Example
     

    Larger practices (greater than 15 clinicians) will be required to do double the amount of activities to achieve a full 40 category points and get their 15 final MIPS points. Medium weighted activities for large practices are worth 10 category points each (requiring 4 be completed to achieve 40 points) and high weighted activities are worth 20 category points (requiring 2 be completed to achieve 40 points).

    Please note a combination of high and medium weighted activities may be completed to achieve a full category score as long as a total of 40 category points are achieved.

    Cost Point Calculation 

    Cost is not manually submitted and is measured behind the scenes at CMS using claims data. Below is a points example for illustrative purposes only:

    Dr. Smith was informed by CMS that she received the full 10 final MIPS Cost points which will be added to her final MIPS score.

    2018 Cost Point Example


    Final MIPS Score for Dr. Smith:

    (Final MIPS Quality Score = 37.5 ) + (Final MIPS PI Score = 22.5)  + (Final MIPS CPIA Score = 15)  + (Final MIPS Cost Score = 10)

     = Total Final MIPS Score = 85

    With a final score of 85 out of a possible 100, Dr. Smith will avoid a 5% penalty to her 2020 Medicare payments and could receive incentive payments as well. 

    2018 Point Example Final