Two New Opportunities for Bonus Points Under MIPS

As your practice continues collecting data for the Merit-based Incentive Payment System (MIPS), you should understand that, in addition to bonus points offered under different performance categories, there are two new opportunities to earn bonus points: Complex Patients and Small Practices. The bonus points apply to the Total Composite Score for the 2018 Performance Year only.

For the Complex Patient Bonus, The Centers for Medicare & Medicaid Services (CMS) offers that: Clinicians can earn up to five bonus points for the treatment of complex patients (based on a combination of the Hierarchical Condition Categories (HCCs) and the number of dually eligible patients treated).1 CMS’ HCC is a risk adjustment model used to calculate risk scores (similar calculation method as the Value Modifier), adjusting capitated payments made for beneficiaries enrolled in Medicare and other plans. The adjustments are made based on diagnosis and demographic characteristics, like age.

For the Small Practice Bonus, CMS has noted that they have: Added five points to any MIPS eligible clinician or group considered a small practice (defined as 15 or fewer eligible clinicians), as long as the MIPS eligible clinician or group submits data on at least one performance category in an applicable performance period.1

This bonus opportunity is awarded automatically to practices with 15 or fewer clinicians, and practices do not have to apply for it.

Our Quality Reporting Engagement Group can assist your practice with your value-based care needs. 

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  1. https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/QPP-Year-2-Final-Rule-Fact-Sheet.pdf