MIPS Cost Performance Category


MIPS 2022 

  • 25 measures, including 15 episode-based measures, 6 acute-episode measures and 2 chronic care episode 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 2018-2022 performance on a quarterly basis via MIPSpro Enterprise or through Healthmonix MIPS Cost Analytics .
30%
of MIPS Composite Performance Score

Changes from 2021 MIPS Cost Reporting

  • The Medicare Spending Per Beneficiary (MSPB) and Total Per Capita Cost (TPCC) measures were revised in 2020 and remain unchanged.
  • Thirteen procedural episode measures remain part of the Cost performance category score. Two were added in 2022.
  • Five acute episode measures remain, with one new measure introduced in 2022.
  • Two new chronic care episode measures were added.

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.

 
2022 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 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, 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.


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