2019 MIPS Cost FAQs
What is the Cost Performance Category?
Additional information about MIPS reporting is available in the 2019 MIPS Executive Summary.
CMS finalized the Cost category weight at 15% for all eligible clinicians participating in MIPS in 2019. This increase from Year 2 of the MIPS program was required by the Bipartisan Budget Act of 2018.
For Year 3 of the MIPS program, the MSPB and TPCC measures will be used in the Cost category along with eight new episode-based measures:
Am I required to participate and report for the MIPS Cost Category?
CMS abstracts from Medicare Parts A and B fee-for-service administrative claims, so MIPS-eligible clinicians do not have to perform any additional data collection or reporting.
Anesthesia services are included in the costs evaluated by the measures, but they only represent a small portion of those costs. Therefore, CRNAs and other anesthesia providers could be included in measure scoring especially if they belonged to a multi-specialty practice that included clinicians that provided the services that trigger applicable Cost Measures.
What services and payments are evaluated by MIPS Cost measures?
The TPCC measure looks at costs associated with primary care inpatient and outpatient services provided to a Medicare beneficiary during the performance year. It calculates the cost of care provided to beneficiaries by an individual EC or group, divided by the number of beneficiaries attributed to the provider or group. Like the MSPB measure, the likelihood of an anesthesia provider or group practice being attributed this measure is low.
Episode-based Cost Measures evaluate the cost of items and services clinically related to the episode of care for the specified clinical conditions or procedures. Assigned services can include anesthesia, which are included in the costs, but they do not trigger evaluation of the measures.
How is the Cost Performance Category scored?
How are Cost Measures attributed?
Acute inpatient medical condition episode-based measures are attributed to the MIPS EC who bills the majority of Medicare Part B claims for the admission. Procedural episode measures are attributed to each MIPS EC who renders a triggering service by HCPCS/CPT codes. CRNAs don't usually bill the majority of Medicare Part B claims or provide services that trigger HCPCS/CPT codes used in the measures.
Are Cost Measures risk adjusted?
The episode-based measures use risk adjustors for the CMS Hierarchical Condition Categories (HCC). They are identified using beneficiaries' Medicare claims history from the period before the episode of care.