MIPS Reporting Requirements: What Counts When You Submit a Quality Measure?

Often, submitted MIPS quality data doesn’t score as expected. Sometimes it’s not scored at all! The problem isn’t usually the measure itself. CMS has a few core thresholds that determine whether a measure is valid, scorable, and worth tracking and reporting.

Each quality measure has a minimum case requirement. This is the number of eligible patients, or the denominator. Each measure requires at least 20 patients in the denominator. Some population-based measures require 200 or more patients in the denominator. If your practice does not meet the minimum denominator, it won’t be counted or scored at all.

For the quality measures, CMS looks for reporting on at least 75% of all eligible patients. This will apply to all payers. For claims-based reporting, only Medicare patients are used. Each measure is different and is scored based on averages from your peer providers. This is considered the CMS benchmark. The further your percentage is from the benchmark score, the fewer points you will be scored.

You may see MIPS reporting with multi-strata. The submission process entails submitting data broken down into multiple, patient subgroups (strata). These strata break down reporting based on certain conditions such as age or disease severity. The score is still an average performance across all strata for the final measure score.

Don’t be confused with reverse measures. In MIPS, "reverse measures” are quality metrics where a lower performance rate indicates better clinical care. This means that you score more points for fewer negative events. Examples include reducing unnecessary tests or adverse outcomes, rather than achieving a high percentage of positive actions.

For quality reporting, eligible providers should report a minimum of six measures including one outcome measure. If you report more than six, CMS will use the scoring for only your top six measures. However, the provider may earn bonus points for submitting additional high-priority or outcome measures. Having a MIPS dashboard and tracking these numbers over time is huge benefit to timely and successful reporting. A partner like Enable Healthcare’s MDnet will help with measures, volume, strategy, and consistency to assure proper reporting.

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