MIPS Scoring Methodology

Legal Disclaimer: Statements contained in this training are WebPT’s interpretation of the QPP rules. The information contained in this training is provided on an “as is” basis with no guarantees of accuracy, completeness, or timeliness and without warranty of any kind, express or implied. The information provided in this training is general in nature and should not be considered legal, consulting, or professional advice. QPP Participants should consult with professional advisors and/or the Center for Medicare and Medicaid Services for advice concerning specific information about QPP.

Let’s review some key components on how MIPS is scored for participating rehab therapists in 2020. Use the following links to jump to that specific section:

MIPS Achievement Points

In 2020, eligible therapists can achieve up to 100 total points across two applicable categories: Quality Measures and Improvement Activities, for the 12-month performance period (January 1 - December 31, 2020).

MIPS Category Quality Improvement Activities
Total Points Available 60 points 40 points
Weight in composite score 85% 15%
Maximum contribution to score 85 points 15 points

Category Score Calculation Equation

[(Points Earned/Total Points Possible in Category) x  Category Weight] x 100 =  Category Points Earned

MIPS Quality Measures

MIPS participants must submit data for at least six quality measures—one of which must be an outcome measure. Each measure is worth a maximum of 10 points unless it is “topped out”. A “topped out” measure is one that reflects consistent performance of the quality actions over a two-year period. “Topped out” measures are worth a maximum of 7 points.

If a therapist reports more than six quality measures, CMS will use the six with the highest performance to calculate their Quality score, creating a category point cap of 60 points. CMS will also include any bonus points you’ve accumulated up to the 10% cap. Please see the bonus points section below.

Because SLPs have fewer than six applicable measures, they must submit every applicable measure in their specialty measure set (130, 181, 182, 226). In this instance, because they are only submitting three measures, their total points available in the Quality category is 40 (instead of 60).

Click here to learn about each measure.

Measure Performance Thresholds

In order to obtain the maximum amount of points for each measure, your data must reflect each of the following:

  • Case minimum is met when each measure is reported for at least 20 patients
  • Data completeness is met when each measure is reported at least 70% of eligible denominator instances (i.e., evaluation/re-evaluation codes billed)
  • Performance rate is based on the percent of instances the quality action(s) described in each measure are reported (numerator instances). Note: Higher performance rates translate into higher points for measures with benchmarks.
  • Successful reporting entails submitting a reporting code that indicates a quality action was performed and the results are documented according to measure specifications.

Remember, each measure is worth a maximum of 7 - 10 points. Your score for each measure is based on your performance compared to the national benchmark for that measure. Note: Measures without benchmarks are capped at three points (Measures 217–222, 478, and HM4-8).

Participants can lose points on each measure in one or more of the following ways:

  • Poor performance
  • Submitted measure doesn’t have a benchmark
  • Submitted measure doesn’t have at least 20 cases
  • Submitted measure doesn’t meet data completion requirement (70%)
  • Submitting the reporting code that indicates a quality action was not performed with no reason documented (in the measure guides, these reporting codes are indicated with the Performance Not Met designation).
Measure Description Scoring Rules
Class 1 The measure can be scored based on performance, meeting all of the following criteria:(1) Has a benchmark;(2) Has at least 20 cases; and(3) Meets the 70% data completeness standard. Awarded 3 to 10 points based on performance compared with the benchmark.
Measures 130, 154, and 181 are topped out and capped at 7 points.
Class 2 The measure meets the 70% data completeness standard but does not have a benchmark or at least 20 cases. Awarded 3 points. 
Measures 217–222, 478, and HM4-8 do not have benchmarks.
Class 3 The measure has a benchmark and was submitted for at least 20 cases but it does not meet the 70% data completeness standard. Awarded 0 points, except for small practices (defined below), which will receive 3 points.
Bonus Points

You can earn one bonus point for each additional high-priority process measure reported beyond the first high priority measure. Additional measures must meet case minimum AND data completeness requirements AND have a performance rate > 0% to earn bonus points. You can earn up to a 10% cap for bonus measures submitted, which equates to 6 points for PTs/OTs and 4 points for SLPs.

The high priority process measures are 130, 154, 155 and 182.

Small Practice Bonus Points

A small practice is defined as a group with 15 or fewer MIPS eligible providers. These groups will receive a small practice bonus of 6 points to the overall score.

Which measures are included in my score (PT/OT)?

Your top six measures will include an outcome measure and your next five highest scoring measures. Note: These are not necessarily your measures with the highest performance rate, as higher performance does not always equate to higher scores.

If you do not submit denominator and/or numerator data for an outcome measure, you will only be scored on your top five measures and you will receive a score of 0/10 for the missing outcome measure.

When there are multiple measures with a historical benchmark and the same score, measures are selected based on the order they’re included in your submission.

Sample Quality Scoring Calculations

Note: The following examples are provided to increase your understanding of how MIPS scores are calculated and are not, in any way, suggesting or representing which measures you should report. We cannot predict nor guarantee any scoring example provided here.  

Let’s review a few sample calculations. Below, we’ll explore the extremes, looking at the calculated minimum and maximum scores achievable for PTs and OTs. Remember, if you do not submit measure data, you’ll receive 0 category points.

Available & Applicable Measure Points

This table shows the minimum and maximum points available for each of the quality measures based on their characteristics (topped out, high priority, and benchmarked). Note: these point values assume 70% data completeness. These values are used below.

Quality Score Calculations

The equation referenced at the beginning of this document is used in the Calculation column.

Improvement Activities

Improvement Activities comprise the second required reporting category. These activities allow participants to show they are actively working to increase the quality and standard of care at their practice. This category is capped at 40 points.

Activity Scoring Information

The activities outlined by CMS include both high-weighted and medium-weighted activities. Participants can submit any combination of activities to reach the 40-point category cap.  Important: Each improvement activity can only be reported once during the 12-month performance period, unless otherwise specified within the improvement activity description.

Additionally, all Improvement Activities must be performed for at least 90 continuous days during the performance period to be considered eligible for attestation (reporting on the QPP website).

Small Provider Groups

Note: If your group falls into the small practice designation (15 or fewer NPIs), is non-patient facing, is in a health professional shortage area, or has a rural designation, your activities are worth more points. This means you won’t have to submit as many activities to achieve the full category point allotment.

Suggested Activities

QPP Website lists over a hundred activities in nine different categories. Our team of experts has selected what we think are the fifteen most relevant activities for rehab therapy practices.

Click here to review the applicable activities and learn how to report them on the QPP website. Then, learn how to select and report on them in the Healthmonix Portal.

Sample Improvement Activities Scoring Calculations

Note: These examples are provided to increase your understanding of how MIPS scores are calculated and are not, in any way, suggesting or representing which measures you should report. We cannot predict nor guarantee any scoring example provided here.  

Like the previous Quality Measures Scoring section, we’ll show you the minimum and maximum calculations. Remember, if you do not complete your attestation, you’ll receive 0 category points.

The equation referenced at the beginning of this document is used in the Calculation column.

Final Score

Your MIPS Final Score is calculated based on your weighted scores in the Quality and Improvement Activities categories.

Important: The minimum final score you must achieve to avoid the penalty is 45 points. This is the neutral threshold. And remember, any adjustments made to reimbursements based on your performance won’t begin until 2022.

Sample Final Score Calculations

Note: These examples are provided to increase your understanding of how MIPS scores are calculated and are not, in any way, suggesting or representing which measures you should report. We cannot predict nor guarantee any scoring example provided here.

Using the minimum and maximum scores previously calculated for each scenario (using PT/OT measures), we’ll show you the expected final score for the following four combinations. Note: We are using the Quality Measure Scores that do not include an Outcome measure for this example.

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