Learn About MIPS
Reporting Requirement
Scoring Logic
Quality
PI
IA
Cost
Summary
Quality Scoring Logic
Max
points
60
30% of final score
Choose 6 quality measures to report on out of 195 quality measures approved by CMS. This must include at least 1 Outcome measure or 1 High Priority Measure (if an outcome measure is not available).
Outcome/High Priority measures are either of the following types – Appropriate Use measure, Patient experience, Patient safety, Efficiency, Care coordination or opioid-related quality measure.
-
CMS automatically calculates up to 4 administrative claims measures for individuals, groups, virtual groups, and APM Entities when applicable and when case minimums are met. These measures include:
-
Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate. (This measure is only applicable to groups and virtual groups).
-
Risk-Standardized Complication Rate (RSCR) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA).
-
Hospital Admission Rates for Patients with Multiple Chronic Conditions.
-
Acute Unplanned Cardiovascular-Related Admission Rates for Patients with Heart Failure.
CMS will automatically score each of these measures if the clinician/group meets the criteria.
Improvement percent score
Clinicians/practices can earn up to 10 percentage points based on the rate of their improvement in the Quality performance category from the previous year.
Topped Out measures
A special scoring cap of 7 points is applied to the measures that are identified as Topped Out.
An alternative benchmarking methodology is finalized for a subset of topped out measures that belong to specialty sets with limited measure choice and a high proportion of topped out measures, in areas that lack measure development, which precludes meaningful participation in MIPS. This ensures fairness where performance has clustered at the top.
Quick tip: Maximum score cannot exceed 100%
*Maximum number of points = Number of required measures x 10