MIPS Cost Performance Category
- Our system captures 25 essential measures from claims data, including 15 episode-based measures, 6 acute-episode measures, and 2 chronic care episode measures
- Enjoy quality care made easy with our automated system
- Track yourMIPS Cost performance over a full calendar year with our system's Total Category Score calculation, which averages the score of all applicable measures
- Stay ahead of the curve with quarterly performance previews through MIPSpro Enterprise or Healthmonix MIPS Cost Analytics.
Need to know for 2023 MIPS Cost Reporting
- If a clinician or group does not meet the minimum number of cases for any of the cost measures, the cost category will be reweighted.
- The most common applicable cost measures are Total Per Capita Cost (TPCC) and Medicare Spending Per Beneficiary (MSPB).
- CMS calculates a single, national benchmark for each cost measure based on the performance year. All MIPS-eligible clinicians who meet or exceed the minimum number of cases for a measure are included in the same benchmark.
- Cost Performance is 30% of your final score
MIPS Cost Final Score
To calculate Cost, CMS will assign 1 to 10 achievement points to each scored measure shown in the table below, based on the clinician or group’s performance compared to the performance year benchmark. Therefore, achievement points for each measure depend on the decile range in which you or your group’s performance falls.
The maximum score for the category is 100%. Additional bonus points will not be applied to a perfect achievement score.
2023 MIPS Cost Measures
MEASURE TOPIC | MEASURE TYPE |
|---|---|
Medicare Spending Per Beneficiary (MSPB) | All patient |
Total Per Capita Costs (TPCC) | All patient |
Routine Cataract Removal with Intraocular Lens (IOL) Implantation Asthma/Chronic Obstructive Pulmonary Disease (COPD) | Procedural Chronic Condition |
Colon and Rectal Resection Diabetes Intracranial Hemorrhage or Cerebral Infarction | Procedural Chronic Condition Acute Inpatient Medical Condition |
Melanoma Resection Knee Arthroplasty | Procedural Procedural |
Elective Outpatient Percutaneous Coronary Intervention (PCI) | Procedural |
Simple Pneumonia with Hospitalization | Acute Inpatient Medical Condition |
Revascularization for Lower Extremity Chronic Critical Limb Ischemia | Procedural |
Screening/Surveillance Colonoscopy | Procedural |
ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI) Sepsis | Acute Inpatient Medical Condition Acute Inpatient Medical Condition |
Renal or Ureteral Stone Surgical Treatment | Procedural |
Non-Emergent Coronary Artery Bypass Graft (CABG) | Procedural |
Lumpectomy, Partial Mastectomy, Simple Mastectomy | Procedural |
Lower Gastrointestinal Hemorrhage Measure Cost Measure | Acute Inpatient Medical Condition |
Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels | Procedural |
Inpatient Chronic Obstructive Pulmonary Disease (COPD) Exacerbation | Acute Inpatient Medical Condition |
Hemodialysis Access Creation | Procedural |
Femoral or Inguinal Hernia Repair | Procedural |
Elective Primary Hip Arthroplasty | Procedural |
Acute Kidney Injury Requiring New Inpatient Dialysis | Procedural |
key benefits
Healthmonix MIPS Cost Analytics are the next big thing in Cost tracking, optimization and revenue-generating insights.
See total Medicare spend, even outside of your network.
Access updated claims data quarterly.
Better impact your MIPS Cost score.
Learn how MIPS Cost Analytics can help you achieve your revenue goals and improve care.
Do you understand how CMS calculates Cost?
Check out our free, webinar: MIPS Cost Category - Back to the Basics to understand the basics of MIPS Cost reporting , learn how to to identify all Cost measures and prepare for 2022 Cost reporting.