How to calculate your Quality score in 2021
This is not a mistake! The 2021 MIPS Composite Score is the sum of four different performance categories.
For most providers, Quality is worth 40 percent of the 100 available points. But in order to earn the full 40 points, an Eligible Clinician (EC) or group must earn 10 points on six (of the 200 measures) or 60 Quality perfomance score points.
Here is how 6 x 10 = 40 works:
1. Each Quality measure is scored based on the actual performance of the provider. The score is calculated by comparing the number of activities that meet the performance for a given measure (numerator) to the number of patients who were eligible for that measure (denominator) as defined by the measure specifications for that particular measure. Measure specifications differ by collection type:
Collection Type refers to the way you collect data for a quality measure. While an individual quality measure may be collected in multiple ways, each collection type has its own specification (instructions) for reporting that measure. Follow the measure specifications that correspond with how you choose to collect your quality data. (eCQM, MIPS CQM, QCDR, Claims, CMS Web Interface)
2. Each Quality measure can earn an EC or group between three and 10 points if the measure meets data completeness criteria by being reported on:
- at least 20 patients, AND
- at least 70 percent of the eligible cases (as defined by the denominator of each measure)
3. The quotient (numerator/denominator) calculated for each Quality measure in #1 above is used to derive a point value from the Benchmark Tables created by CMS. The benchmark point value will vary by collection type.
4. ECs and groups are encouraged to report more than six measures, but only the highest six scores calculated from the benchmark tables are added together to get the Total Quality Achievement points.
5. Some Quality measures may have bonus point(s) added to their benchmark point value.
6. Solo practitioners and small practices (15 or fewer providers) are awarded six additional bonus points. These "small practice" points are added to the Total Quality Achievement Points (#4) and bonus points (#5).
7. The sum of all of the Quality Achievement points, bonus points and small practice bonus points are divided by the total number of possible points for that eligible provider or group. For most practices that denominator will be 60.
This Total is the 2021 Quality Performance Score for the provider or group.
8. The 2021 Quality Performance Score is multiplied by the Quality category value of 40 percent to get the total number of Quality points that will be part of the MIPS composite score for that EC or group.
9. However, the value of Quality performance category may be more than 40 percent! If an EC or group has their Promoting Interoperability category re-weighted, their Quality score will be valued at 65 percent of the MIPS Composite Score, not 40 percent. (The Quality Performance Score for this EC or group would be multiplied by 65%.)*
*Reweighting is automatic for special status providers and groups or for providers who meet the criteria and file for the Promoting Interoperability Hardship Exception.
There you have it! For 2021, in the Quality Payment Program Merit-based Incentive Program Quality Category:
6 X 10 = 40!
- You don't have to have an EHR to avoid a penalty or earn a positive adjustment or bonus.
- It does not cost you any money to submit data.
- You can now check your 2021 eligibility on the QPP website!
If you are an eligible clinician, a LAMMICO insured and have not already implemented a process for capturing or reporting MIPS data in your practice, contact LAMMICO and let us help you! If you already have a MIPS process, we can be an additional resource and discuss options regarding MIPS. There is no charge for our consultation. These services are provided to you because you are a LAMMICO insured.
Participation in the Quality Payment Program may also help you mitigate your malpractice risk through tracking and improving quality care (Quality measures), increasing patient engagement and satisfaction (Improvement Activities) and improving communications using secure electronic transmissions between providers and with patients (Promoting Interoperability).
Contact LAMMICO Practice Management Specialist, Natalie Cohen, MBA, MHA, at 504.841.2727 or email@example.com.
This is not legal or financial advice, and is not intended to substitute for individualized business or financial judgment. It does not dictate exclusive methods, and is not applicable to all circumstances.
This content is accurate as of February 23, 2021. This article was previously published in 2019 and was updated for 2021.