BC Advantage - 2018 Issue 12
MIPS Cost Category Unpacking a Mystery
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Article Overview
This article explains the 2019 MIPS cost category at a high level for clinicians and coding/reimbursement professionals, with emphasis on how CMS uses administrative claims data, how the category is weighted, and how the major cost measures differ. It focuses on the general structure of total per capita cost, Medicare spending per beneficiary, and episode-based measures, along with attribution, case minimums, and scoring concepts relevant to nephrology practices and other Medicare providers.
Why This Topic Matters
Understanding the cost category helps practices anticipate how CMS may assess performance without direct submission, especially as cost carries a growing share of the MIPS score. The article is useful for anyone trying to gauge whether cost measures may affect individual clinicians or groups and how future measure development could change exposure over time.
What You Will Learn
- How the MIPS cost category is weighted for 2019 and how that weighting fits into broader MIPS scoring
- How CMS relies on administrative claims data to calculate cost performance
- The general structure of the main 2019 cost measures and how they differ from one another
- How attribution and minimum case requirements affect whether cost measures count toward scoring
- Why episode-based measures are important to watch in future years
Who Should Read This
- Nephrologists
- Medical practice managers
- Coding professionals
- Reimbursement specialists
- Quality reporting staff
- Clinicians participating in MIPS
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