MIPS performance categories are a set of evaluation criteria for eligible clinicians. As we know, these categories have varying weights assigned, contributing to the total MIPS score. Do you know what the category score distribution in MIPS 2023 is? Well, in MIPS 2023 reporting, there is no change in each category score distribution. It is the same as of 2022. However, CMS has modified the measure lists and made a few other changes. For instance,
So, with these modifications and some others, it’s not going to be easy to survive MIPS 2023 safely. Eligible clinicians are revising their reporting strategies to achieve maximum scores by performing even better. Therefore, understanding the unique scoring requirements in each performance category is important.
Today’s blog especially covers all the details on performance category scoring in MIPS 2023. Thereby, those participating in PY 2023 will be able to score maximum points to avoid MIPS penalties.
Before further delay, let’s explore all about the performance categories and changes brought by MIPS 2023.
Replacing the PQRS in the MIPS program, this category acts as a quality inspector for clinicians’ performance. The eligible clinicians usually select different measures provided in the CMS-approved list. During the measure selection process, it is necessary to consider their applicability as well. Afterward, they will select the data submission method. Then, collect data throughout the performance year. And later, submit it in the reporting phase.
On each measure, participants may lose points in one or more of the following ways:
The national benchmarks for quality measures in MIPS 2023 are contingent upon the following data sources and historical information collected from PQRS and CAHPS surveys. These benchmarks impact the allocation of points, ranging from 0 to 10, for MIPS-eligible clinicians. For MIPS 2023 performance periods, the historical benchmark for eCQMs, MIPS CQMs, QCDR measures, and Medicare Part B claims measures is actual data submitted for the 2021 performance year.
Eligible clinicians usually have to fulfill strict data completeness requirements. Generally, it is based on their collection type. All groups and individual participants must report 70% of the data on eligible encounters during PY 2023. Similarly, those who choose Part B claims measures must report on 70% of their Medicare Part B patients.
Again, the eligible clinicians’ submission and/or collection type may impact the submission deadline. Anyhow, it’s customary to submit the measures before March 31 of the year next to the performance year.
One way CMS assesses the clinician’s performance is through the implementation of various improvement activities. This category makes up 15% of the MIPS final score. And one amazing fact about IAs is that this is a truly new category of MIPS program. In other words, it has not been derived from any previous QPP program.
The QPP Resource Library has a list of Improvement Activities (IA) applicable for MIPS 2023. Go and choose the most relevant IAs for your participation in MIPS reporting. P3 Care, as an MIPS-qualified registry, can also help you in your selection. We provide MIPS consulting services to ease your selection.
Each activity in the Improvement Activities list is classified as either ‘medium-weighted’ or ‘high-weighted’. A MIPS participant intending to score a maximum of 15 points must go with the following combinations:
| Clinician in a small group with 15 or fewer providers | ● 1 high-weighted activity OR ● 2 medium-weighted activities |
| Clinician with a special status of Non-patient Facing, HPSA or Rural | ● 1 high-weighted activity OR ● 2 medium-weighted activities |
| Clinicians working in larger groups with 16 or more providers | ● 1 high-weighted activity and 2 medium-weighted activities OR ● 2 high-weighted activities OR ● 4 medium-weighted activities |
Remember, a minimum of 50% of TINs under a group must report for IAs their group is being attested to.
The data submission deadlines for Improvement Activities are also the same. That’s why all eligible clinicians must submit their activities before March 31, 2024.
The MIPS program initially introduced this category as the Advancing Care Information Category. Later, it established the Promoting Interoperability category of MIPS. Clinicians can usually get 25% of their MIPS score by reporting these category measures. All they need for this purpose is an EHR technology certified to the 2015 Edition Cures Update criteria. They have to report selected measures for a continuous period of 60 days in MIPS 2023.
Yes, it is possible. However, clinicians must meet certain predefined criteria. Then, you can shift the Promoting Interoperability weight to 0%. In contrast, it strengthens the Quality component to a significant 55% of your overall score.
| Qualified for Automatic Re-weighting | Not Qualified for Automatic Re-weighting |
| Small practices Clinical social workers Physical therapists Occupational therapists (OTs) Qualified audiologists Qualified speech-language pathologists (SLPs) Clinical psychologists Registered dietetics or nutrition professionals | Nurse practitioners (NPs) Physician assistants (PAs) Certified registered nurse anesthetists Clinical nurse specialist |
Cost Category (30%)
This category shares its origins with the value-based modifier program. Just like the Quality category, this Cost category also has a 30% weightage of MIPS final score. However, clinicians do not have to submit data for this category as CMS calculates the scores itself.
MIPS 2023 reporting, with some minor changes in each of its performance categories, requires compelling reporting strategies to perform well. Otherwise, clinicians can face MIPS penalties with a little carelessness. That’s why we suggest providers always depend on MIPS-qualified registries like P3 Care, as the reporting gets tougher every year. With our experience and MIPS consulting services, you can secure a safe spot in MIPS. Not only this, but you can also get the MIPS incentives by improving your performance as a whole.
