Practices will need to submit data for at least two of categories* to receive enough points to avoid a 7% penalty to their Medicare Part B Fee Schedule in 2021. For 2019 the minimum final MIPS score amount must be greater than or equal to 30 MIPS points to avoid the penalty. Any MIPS score achieved over 30 points could provide an incentive payment, anything below 30 points will result in a penalty.
For more information about the MIPS program and steps to take on getting started please review our MIPS web page.
*Although the Quality category alone offers enough final MIPS points to meet the 30-point benchmark, we highly recommend submitting data for an additional category. Quality category points are awarded on a sliding scale and are dependent upon performance of each individual measure reported, therefore the 45 final MIPS points for Quality is not guaranteed simply based upon participation.
QUALITY Point Calculation
The Quality category accounts for 45 final MIPS points out of the possible 100 final MIPS score. This category requires a year’s worth of data (Jan. 1 through Dec. 31, 2019) on six 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 one 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 45 final MIPS Quality points available to her final MIPS score:
45 final MIPS Quality points x .75 or 75% = 33.5 final MIPS points.
Dr. Smith’s FINAL MIPS Quality score is 33.75 points, which will be counted towards her final MIPS score. This point total is more than the 30 MIPS points benchmark, therefore Dr. Smith will avoid a 7% penalty on her 2021 Medicare payments even if she chooses to only participate in the Quality category. Additionally, Dr. Smith could potentially receive an incentive payment for achieving > 30 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.