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MIPS: Cost

MIPS: Cost

MIPS Performance Category Overview

The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) replaced the Sustainable Growth Rate (SGR) and created the Merit-based Incentive Payment System (MIPS). 

Starting January 1, 2017 eligible clinicians (ECs) will report under MIPS. Unless they qualify for an exemption, do not meet the minimum reporting threshold, or are part of an Advanced APM, all physicians, physician assistants, nurse practitioners, clinical nurse specialists, or certified registered nurse anesthetists who bill Medicare are considered ECs and must participate in MIPS.

For the 2017 reporting period, clinicians have the option to pick their pace with three reporting periods for MIPS:

  • Test Pace: Report some data in 2017.
    • 1 quality measure, or 1 improvement activity, or 4/ 5 required advancing care information (ACI) measures.
  • Partial MIPS Reporting: Report one or more MIPS performance categories for at least 90 consecutive days in 2017 (must begin reporting by October 2, 2017).
    • 1+ quality measure, or 1+ improvement activities, or 4/ 5 required ACI measures
  • Full MIPS Reporting: Report all MIPS categories for at least 90 consecutive days in 2017 (must begin reporting by October 2, 2017).

ECs will report on three categories that will add up to a composite performance score (CPS). The CPS will be used by CMS to determine whether or not an EC will receive a bonus payment or will be subject to a payment reduction. CY 2019 payment adjustments will be based on CY 2017 reporting. Learn more about the MIPS program here

Cost Performance Category

The Quality MIPS performance category will count for 0% of the total CPS for the 2019 payment adjustment period. The 2019 payment adjustment period will be based on data submitted on the 2017 reporting period. Although the Cost category will count for 0% of the total CPS for the 2019 payment adjustment period, ECs will still receive 2017 performance feedback for the Cost category. The Cost category will increase to 10% of the CPS for the 2020 adjustment period (2018 reporting period). The Cost category will not require any data submission as it will be calculated from claims data and will replace the Value-based Payment Modifier. Learn more here