Reporting MIPS: How to Earn Rewards in the Quality Category

Practices have already chosen their measures to report for the 2018 performance year (to be submitted to CMS in early 2019) and, hopefully, understand all the implications of changes from the previous year. This article will focus on the Quality category in MIPS reporting.

Completeness and a Full Year of Data

For the Quality category practices will need to submit a full calendar year of data. Gone is the option to do a flexible reporting period. In addition, practices must meet the 60 percent data completeness threshold. That means practices must report on 60 percent of all qualifying visits to earn or receive points for this category. Also, each of the quality measures should have at least 20 cases in the denominator to potentially achieve the full score for the measure.

CMS made some adjustments in scoring for large practices (16+ eligible clinicians) versus small practices (1-15 eligible clinicians), making it a little easier for small practices. Quality measures that are submitted but do not meet the data completeness criteria (regardless of whether they have a benchmark or meet the case minimum) will get at least three points on any measure, but large practices will only get 1 point if they do not meet the data completeness criteria.

Improving Scores - Year after Year

CMS will continually look at measures to see how practices improve from year to year. If it looks like most practices are achieving a high level of success, CMS will consider “topping out,” or capping, the maximum allowable points for those measures. They will also eventually phase out those topped out measures from the MIPS program.

Practices who fully participated in the Quality category in 2017 will have the opportunity to earn ‘bonus points’ for improvement. The total cannot exceed 10 percentage points as a part of the total overall category score.

While industry leaders continue to weigh in with their concerns and criticisms of the MIPS reporting system, the move to providing a high-quality, cost-effective healthcare model will not go away.

For help understanding your measures, making sure you are collecting the correct data, and reviewing the data on a regular basis, providers can reach out to the Quality Reporting Engagement Group for answers to questions and guidance:

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or call 877-570-8721 x2.