CMS eliminating Cost category for 2020 MIPS scoring

May 21, 2021

Yesterday, CMS announced the agency is not scoring the Cost category for 2020 Merit-based Incentive Payment System (MIPS) participants due to reporting volumes being so heavily affected by the Covid-19 Public Health Emergency and other factors.

For 2020 MIPS, which will impact 2022 Medicare Part B payments with bonuses or penalties of up to +/-9%, Cost was set to comprise 15% of an individual or group’s overall score. However, CMS said due to a significant decrease in available data required to calculate scores, the category will be reweighted to 0% with the 15% being transferred to another MIPS category, such as Quality.

Credit: CMS

Another factor that likely affected data volumes was CMS’s decision to allow most MIPS participants an easy path to opt-out of 2020 reporting through a hardship exception due to the PHE. Any group or individual who only submitted data in one category received an automatic exemption, and there were options for most other participants to apply for the exception.

One of four MIPS categories, Cost measures a provider or group’s payments when providing care to Medicare patients. Participants are scored relative to one another for measures in which they meet case-volume thresholds using a benchmarking system.

For 2021 MIPS participation, Cost is set to comprise 20% of a group’s overall score.

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