Scoring

When you submit measures for the Quality category, your percentage performance is assessed against benchmarks to determine how many points you earn for each measure. You can receive anywhere from 3 to 10 points for each measure, not including bonus points. Benchmarks are specific to the submission method: claims, registry, and IRIS Registry.

Each measure’s benchmarks are represented in terms of deciles. Points are awarded within each decile. If your percentage performance falls within the first or second decile you’ll receive 3 points. If you’re in the 3rd decile you’ll receive somewhere between 3.0 and 3.9 points depending on your exact position in the decile. Higher deciles earn a corresponding number of points, as shown in the table below.

You must report at least 75% of eligible encounters for each measure, regardless of payer, to achieve data completeness and receive at least 3 points for each measure.

Small practices (15 or fewer clinicians) will receive 6 bonus points for submitting data for at least one quality measure. Small practices may report at least one case for each measure to satisfy the data completeness requirement and qualify for a minimum of 3 points for each measure.

You must report 1 outcome (or intermediate outcome) measure. If no outcome measures are available, you may report 1 high-priority measure.

You can earn 2 bonus points for each additional outcome measure and 1 bonus point for each additional high-priority measure you report.

Small practices (15 or fewer clinicians) qualify for a six-point bonus.

Although bonus points are available, scores in the Quality category are capped at 100%. In other words, the bonus points can help make up for deficiencies within the Quality category but cannot carried over to make up for deficiencies in other MIPS performance categories.

Quality is worth 45% of your total MIPS score. Your Quality performance is calculated using the following formula.