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MIPS: Your Feedback Reports and How the Cost Category can Impact Reimbursements


Feedback Reports:
The 2020 Performance Feedback Reports should be available for review in early August. For practices who have not previously accessed their information, you can find them on the QPP website using your HARP account.  Once you are logged in, the menu to the left of the screen will have a tab for Performance Feedback.

Practices are encouraged to review their feedback reports.  Payment adjustments and any potential bonus points will be shown in the report which effects your Medicare Part B reimbursements from CMS in 2022.

If you do not agree with what you see in the Feedback Report based off your submitted numbers, you can file an application for a Targeted Review.  CMS will review your submission data. The deadline for asking for a Targeted Review is October 1, 2021.

MIPS Cost Category:

In 2021, the Cost category is weighted at 20% of the overall MIPS score, but that percentage will rise to 30% by the 2022 performance year (as mandated under MACRA), offset by a drop in the Quality category performance score. The percentage impacts the total overall performance score and the ensuing reimbursement rate.

Practices do not submit data for the Cost Category - this data comes from administrative claims to calculate the Total per Capita Cost (TPCC) with a 20-case minimum, Medicare Spending per Beneficiary (MSPB) with a 35-case minimum, and several episode-based measures.

                Understanding TPCC: this metric assesses the overall cost of care delivered to a Medicare patient, with the focus on primary care. Exclusions were permitted to those practices in specialties who are not focused delivering on primary care services, like: [EK1] general surgery, urology, ophthalmology, etc.).  Some Advanced Practice Providers within a specialty practice may not meet the specialty exclusion, especially if they are billing under their own NPI, so some specialty practices may still see data under this metric.

             Understanding MSPB: this metric assesses the cost of care for services related to qualifying inpatient hospitals stays (immediately prior to, during, and after) for a Medicare patient. This measure is split into two types of episodes – medical and surgical.  The cost of a medical episode will be attributed to the practice or physician responsible for at least 30% of the E/M services during the inpatient stay. The cost of a surgical episode will be attributed to the physician who performs a surgery during the inpatient stay.

Also applied in the Cost category are Procedural Episodes (like a knee arthroplasty or a hemodialysis access creation, as a few examples) or Acute Inpatient Medical Condition Episodes (like simple pneumonia with hospitalization).

In 2020, CMS was not able to reliably calculate the cost measures due to the pandemic, so they reweighted the Cost category and practices will not see data from that time period.  The first time practices will see how they performed on the new and revised cost measures will be in summer of 2022 based on 2021 claims data.

The information in this blog was taken from a webinar held in July 2021 titled: MIPS Webinar Cost/Feedback Reports & Security Risk Analysis.  To view the webinar, click here, and to get assistance with your MIPS reporting, contact the team of experts at: