CMS has provided every detail for MIPS 2022 Quality Measure program. However, we have provided an easy guide for MIPS Quality measure reporting. CMS has implemented MIPS 2022 with several modifications just to cope with the challenges QPP has to deal with. Apart from all those significant changes, let’s precisely focus on the MIPS categories.
As we know that MIPS has four performance categories, each constituting a particular weightage of MIPS. Last year in MIPS 2021, CMS gave zero weightage to the cost category. While on the other side, the quality category has the maximum weightage i.e., 55 %. But in the performance year 2022, there is a big shift in both of these categories. CMS has not emphasized on cost category as well but has also given equal weightage to the two categories. So, from now, MIPS clinicians have to report on both fronts for not missing their 30% final score in each category individually.
Above we have provided a precise view of two MIPS performance categories. However, for a clear understanding, we are only going to discuss the MIPS quality measures category.
Though we have a lower weightage of MIPS 2021 quality measures, CMS has added a favorable clause in MIPS 2022. According to CMS,
“If a MIPS participant is being excluded from any of the other three performance categories, the respective category’s weight can be added to the quality category.”
Reporting Requirement for MIPS Quality Measure
MIPS 2022 quality me asks an eligible clinician to report a minimum of 6 MIPS 2022 quality measures with one outcome or high-priority measure in combination.
Furthermore, CMS has two additional administrative claims-based measures on its list. These are not compulsory measures for everyone to report especially. Rather, CMS will automatically calculate the participant’s performance for the two measures, if applicable. This implies that clinicians do not have to worry about the data collection and submission for these two measures.
- First is a Hospital-Wide All-Cause Readmission quality measure
The measure application criteria set by CMS emphasizes the scoring group practices only for this measure. So, they must have a minimum of 16 NPIs / 200 cases fully ascribed to them. - The second measure is Risk-Standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions
CMS has again entitled the group practices for this measure. Alongside, they must have a minimum of 16 NPIs / 18 cases fully ascribed to them.
Available Collection Types for MIPS 2022 Quality Measures Reporting
- Medicare Part B Claim (Only allowed for the MIPS participants in small practices with 15 or fewer providers)
- Qualified Clinical Data Registry (QCDR)
- Qualified Registry (QR) as Third-party Intermediary
- CMS Web Interface (For groups with 25 or more NPIs; This collection type will be closed for MIPS reporting in the future)
- Electronic Health Records (EHR) for eCQMs
- A CMS-approved Survey Vendor for CAHPS (specified for the group in particular along with another data submission type in junction)
CMS Action Plan for not Meeting Quality Measure Requirements
Even though, every MIPS clinician has pre-planned their strategies before the commencement of MIPS 2022. So, if they go according to their plan of action, they will never miss out on anything and complete their MIPS quality category requirement to full. Anyhow, here we have concerns if they fail to report all 6 measures or an outcome or high priority measure in certain conditions. If it happens so, CMS has already confirmed its proceedings in advance.
Thus, CMS will go for a validation process that will decide the fate of such participants. This process will check if there is any measure that such a clinician can report. If not, then CMS will move to other steps. CMS will give zero points for not reporting additional MIPS 2022 quality measures. Consequently, this will influence your MIPS final score to a great extent.
How to Gain Performance Achievement Points in the MIPS Quality Category?
QPP Resource Library provides complete instructions about the MIPS Eligible Measures Applicability (EMA) process. MIPS participants can get 3 to 10 achievement points for the quality measure set reported in PY 2021. However, there is another criterion for awarding these achievement points to the MIPS participants.
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Case Minimum Requirement; 20 cases at least. |
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Data Completeness Threshold;
70% of Medicare Part B Claims / 70% of applicable patients across all payers while reporting via a QR, QCDR, or EHR. |
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MIPS Benchmark;
Each performance year, CMS publishes a historical benchmark file (based on performance information from the previous two years) so that doctors have a performance goal to work towards. The baseline for the measure is either historical or performance-based. Thereby, CMS employs national benchmarks to grade physicians and organizations on each quality measure. Each benchmark is described in deciles, where each decile identifies the range of points generally available for the measure. For instance, if your performance on a measure is within decile 5 of the benchmark, your score on the measure might range from 5 to 5.9 points, depending on how well you do. |
Conditions for Specific Measures Points Restriction
Nevertheless, there are other situations in which CMS will limit the number of points that are available for a certain measure. These circumstances are mentioned below:
- If a clinician or group meets the data completeness requirements but the measure does not
- have a benchmark or
- exceed the case minimum
For both the aforementioned scenarios, they can only receive 3 points for that measure.
- No matter the case minimum or benchmark, a clinician or group will receive 0 points (or 3 points for those in small practices) for measures that are provided but do not match the data completeness criterion.
- A 7-point scoring cap applies to several measures. CMS has deemed them as “topped out” because of historically high-performance rates. Only seven points may be earned by clinics with perfect execution of these measures.
- Moreover, CMS has approved a new policy to encourage the use of new MIPS 2022 measures. As long as data completeness and case minimum standards are fulfilled, new measures will be subject to a 7-point scoring floor in the measure’s first year and a 5-point scoring floor in the measure’s second year starting with the 2022 performance year.
Conclusion
That’s all about the MIPS 2022 Quality Category. You can find more comprehensive detail on QPP Library Resources. Moreover, QPP MIPS being a QR offers its MIPS consultation for all clinicians in facilitating them in PY 2022 reporting. We have a team of well-versed members, who help you in improving your performance to get the highest MIPS reporting score.
