MIPS Cost Performance Category
2021 MIPS
- 20 measures, including 2 overall primary care measures, and 18 episode-based measures, are automatically captured through claims data.
- Total Category Score is averaged from the score of all applicable measures.
- Measure performance is tracked over a full calendar year.
- Clinicians can preview 2018-2021 performance on a quarterly basis via MIPSpro Enterprise or through Healthmonix MIPS Cost Analytics .
No changes from 2020 MIPS Cost Reporting
- The Medicare Spending Per Beneficiary (MSPB) and Total Per Capita Cost (TPCC) measures were revised in 2020 and remain unchanged.
- Eighteen episode-based measures remain part of the Cost performance category 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.
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 | Procedural |
Intracranial Hemorrhage or Cerebral Infarction | Acute Inpatient Medical Condition |
Knee Arthroplasty | 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) | 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 every 90 days, instead of 18 months after-the-fact.
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, instructional videos to understand the basics of MIPS Cost reporting , learn how to to identify all Cost measures and prepare for 2021 Cost reporting.
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