Below are the common questions associated with the Merit-based Incentive Payment System (MIPS) Cost Performance Category.
1. What percentage of the total MIPS score is the Cost performance category?
The Cost performance category is 20% of the eligible clinician or group’s final MIPS score. If the EC or group cannot be assessed for any cost measure, the 20% weighting will be redistributed to the MIPS Quality category.
2. What measures are included in the Cost performance category?
CMS has approved twenty (20) cost measures for the 2020 performance year. The measures are assigned to three types: 1.) Population-Based; 2.) Procedural Episode-based; 3.) Acute inpatient medical condition episode-based. A list of the measures and their specifications can be downloaded from the Quality Payment Program Resource Library.
3. As an anesthesiologist or part of an anesthesia group, will I be assessed under the Cost performance category?
Anesthesiologists and their practices, when they have provided either the plurality or services or the plurality of costs associated with a measure, may be assessed under the Cost category. Most anesthesiologists and anesthesia groups are assessed under the Medicare Spending Per Beneficiary (MSPB) measure. It is unclear in 2021, how many anesthesiologists and anesthesia groups will be assessed under other cost performance category measures.
4. How are the cost measures scored?
Points for the cost measures are determined by comparing the EC or group’s performance on a measure to a benchmark that is established during the performance year (there are no historic benchmarks).
5. Will the facility-based scoring option be used for my MIPS Cost performance category score?
Facility-based measurement scoring will be used for Quality and Cost performance category scores when the EC or group is identified as a "facility-based," is attributed to a facility with a fiscal year 2021 Hospital Value-Based Purchasing (VBP) Program score and the resulting facility-based score is higher when compared against MIPS Quality measure data submitted by the EC and group and their calculated cost measure score.
6. What do I need to do to submit cost measure data?
ECs and groups do not need to report any data to be scored under the MIPS Cost performance category. CMS uses claims data to assess an EC and their group.
7. Where can I review my cost measure performance for the year?
Each year (typically in the summer after the performance year), CMS releases feedback reports to ECs and their groups. Practices should download their feedback reports from the Quality Payment Program webpage or through their CMS Enterprise Portal and assess their group’s score in the cost category. CMS allows a group to appeal any scores, typically within a 60-day period.