MIPS 101: Demystifying the Quality Category | blogMD
Nov 17

MIPS 101 – Demystifying the Quality Category

Do you know everything about the Quality category?

If you’ve elected to take part in the Merit-based Incentive Payment System (MIPS), you likely have one question looming in your mind – how can I make this program work in my favor so that I not only don’t lose money, but also get a payment increase? A good place to start is with the Quality category. With its weight of 60% of your overall score, this category could make or break your MIPS success. So how exactly does the Quality category work? Let’s take a closer look.


If the Quality category of MIPS feels somewhat familiar, there’s good reason. This category replaces the Physician Quality Reporting System (PQRS) as well as the quality portion of the value modifier. 60% of your total MIPS Final Score for 2017 will be determined by your performance in the Quality category, but because this category replaces programs that physicians were already familiar with, reporting on this category should prove to be an easy transition.

What are the reporting requirements for Quality category performance?

2017 is a transition year for MIPS, and as such physicians are able to choose the pace at which they wish to report from three options:

  • Test pace – In this option, physicians will submit a minimal amount of data for any point after January 1, 2017. They will need to report on one Quality Measure or one Improvement Activity or four or five Required Advancing Care Information Measures. By reporting at this pace, physicians will avoid a negative payment adjustment but should not expect much in the way of a positive adjustment either.
  • Partial year – In this option, physicians will report for any 90-day period starting between January 1, 2017 and October 2, 2017, with data due for submission by March 31, 2018. They will need to submit at least six Quality Measures, including at least one outcome measure. Physicians who choose this reporting pace can expect to receive a small positive payment adjustment.
  • Full year – In this option, physicians will report for the entire year of 2017. They will need to submit at least six Quality Measures, including at least one outcome measure. Participating at this level will elicit a modest positive payment adjustment for the physician, with exact positive adjustments being based upon the performance data submitted.

It’s important to note that physicians who neglect to participate in the Quality Payment Program (QPP), including MIPS, at all for 2017 will automatically receive a negative 4% payment adjustment.

Physicians can choose the six Quality Measures they report on from the 271 available measures. One of the reported measures must be an outcome measure or a high-priority measure. Physicians can also choose to report on a specialty-specific set of measures if they prefer to do so.

How Does Quality Performance Scoring Work?

Each quality measure has an available score of 3 to 10 points. The amount of points received is based on performance in relation to available benchmarks. As long as a measure has a benchmark, the physician can receive up to 10 points. Benchmarks exist when there are at least 20 reporters for the measure and case volume is met or exceeded, data completeness criteria is met or exceeded, and performance is greater than 0%. When a benchmark doesn’t exist, the clinician will receive 3 points. There are also bonus points available for submitting additional high-priority measures. Two bonus points will be awarded for each additional outcome and patient experience measure and one bonus point will be awarded for each additional high-priority measure as well as for submitting electronically using CEHRT.

A physician’s Total Quality Performance Score is determined by adding the points the physician earned on the six required quality measures to any bonus points received and dividing that total by the maximum number of points available, which is calculated by the number of required measures times 10. A physician’s maximum score cannot exceed 100%.

How to optimize your Quality category score

In order to optimize one’s quality score, a physician must report on a minimum of six measures, at least one of which is an outcome measure. At least 50% of a physician’s relevant patient population must be reported on depending upon submission type. Physicians should choose the measures that are most relevant to their patient population as well as those that present the best opportunity to score well in relation to the established benchmarks.

While it may seem intimidating, with some consideration and strategizing it is well within reach to score well on the MIPS Quality Category. To give yourself the best opportunity, make sure you are using an ONC certified EHR such as MicroMD to collect and submit your data.

For more information on MicroMD and how we can help you reach your MIPS goals, visit micromd.com or call 1-800-624-8832.

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1 Comment

  1. agency management systems
    January 3, 2018 at 10:55 am · Reply

    Helping patients know the difference between the two is most beneficial when it comes to communicating with the doctors and nurses. There are medical terms and situations where the patients have no idea what to say or what the medical staff may be telling them regarding certain situations. EHR’s and EMR’s are a perfect example of that, especially when one word makes a difference. I agree with this point of view.

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