Alright alright alright! We made it to Part 4. Phew!!! As hopefully you know by now, in Part 1 of this series, we discussed the Basics of MIPS Scoring, and in Part 2, we discussed scoring for the Quality category. In Part 3, we discussed Improvement Activities scoring. Today, in our big series finale, Part 4, we’ll cover Advancing Care Information (ACI) scoring, plus an overview of the MIPS final score and payment adjustment calculation. And, away we go!

**The Basics of Scoring the Advancing Care Information Category**

One note before we hop into the weeds of scoring ACI. There are many exceptions to reporting ACI, so be sure to investigate those in case one applies to you or your group. The ACI exceptions are sometimes also called “ACI reweighting” because your overall score will be reweighted if one of those exceptions applies. See page three of this guide for a good resource to learn more. But, for the purposes of this post, let’s assume that you are required to report the ACI category and therefore, your MIPS score has not been reweighted.

Your overall ACI score has three parts, and each part is weighted differently. We have:

1. The base score, which is weighted at 50% of your total ACI score;

2.The performance score, which is weighted up to 90% of your total ACI score; and,

3.The bonus score, which is weighted up to 15% of your total ACI score.

If combining your scores in each of these parts results in a score higher than 100 points, you’ll automatically get full credit for the ACI category of MIPS. Now let’s look at each part in turn.

**ACI Base Score: Required, and Worth 50% of Your Total ACI Score**

In order to earn any points for the ACI category, you must successfully report the base score measures. But, luckily, successfully reporting the base score measures is relatively straightforward. To do so, you must:

1. Submit a “yes” answer for the security risk analysis measure; and

2. Submit at least a “1” in the numerator and denominator for the rest of the base score measures, indicating that you completed that measure at least once during the reporting period.

The base score measures consist of either 4 or 5 measures, depending on what edition your electronic health record (EHR) is. To find out which EHR edition you use, visit here and then here. Depending on your EHR edition, here are the two separate sets of measures that you can report on:

Again, as long as you submit a yes to the security risk analysis measure, and at least 1 for the numerator and denominator for each other measure in your applicable base measure set, then you’ll get the full base score points. Easy, right? Let’s look at the performance score.

**ACI Performance Score: Optional, but Worth Up to 90%**

For the performance score part of ACI, you can choose the number of measures to report, with the maximum number dependent on the measure set you are reporting. Your measure set choice will be the same as it was for the base score, so no need to re-determine that for the performance score. Here are the two measure set reporting options, with corresponding measures:

For most measures, you will report a number for both a numerator and a denominator. With some nuance, the denominator is the number of times your practice could have performed a certain act, and the numerator is the number of times your practice actually did perform that act. A performance rate is then calculated for each measure, based on the numerator and denominator. That performance rate is used to determine how many points you will receive for each measure, with most measures being worth 10% of the performance score (see above chart for each measure’s worth). The better your performance rate, the higher your score, as illustrated here:

Add up each of the points from these measures, and you’ll have your performance score for the ACI category.

**ACI Bonus Score: Optional, and Worth Up to 15%**

Last but not least, we’ve got the ACI bonus score. There are two ways you can earn bonus score points:

1. Indicating “yes” to reporting to public health and clinical data registries beyond the immunization registry reporting measure. Doing so earns you a 5% bonus.

2. Indicating “yes” that you completed 1 of your improvement activities using certified EHR technology. Doing so earns you a 10% bonus.

If you complete either one of these activities, you will receive bonus points for your bonus points score.

Each of these individual scores is then added up to get your total ACI score. As mentioned above, if each part of your score adds up to more than 100%, you’ll automatically get full credit for the ACI category, which is worth 25% of your overall MIPS score.

**The Final Score and Payment Adjustment**

Ok, the finish line is in sight!! We’ve reviewed scoring for each of 2017’s weighted MIPS categories, so now let’s take a look at how all that comes together to determine the most important factor: your payment adjustment.

Once CMS determines your score from each of the categories, each score is then weighted accordingly, then added up and multiplied by 100 to get a your final score, which will be between 0 and 100.

Your score then corresponds to your payment adjustment, along the following scale:

The amount of the payment adjustment itself will depend on how other eligible clinicians perform because the amount of the payment adjustment is scaled. But, if you do exceptionally well - aka higher than 70 points - you can receive an exceptional performance bonus, in addition to the standard bonus. The amount of the exceptional bonus will also depend on how many other eligible clinicians score about 70 points.

And that, ladies and gentlemen, is IT! That is how CMS will calculate you MIPS score and corresponding payment adjustment. Easy, right? Well, if not easy, I hope, at this point, MIPS scoring is at least clearer than mud. But, if it isn’t - or if you are interested in learning more about pMD’s suite of products which includes MIPS Registry, charge capture, secure messaging, and care coordination software and services - please contact pMD. We’d love to hear from you!

**References:**

Quality Payment Program Merit-based Incentive Program (MIPS) Scoring Guide 101 for the 2017 Performance Period,

*available at*https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/MIPS-Scoring-101-Guide.pdf

Advancing Care Information Measure Specifications,

*available for download in a zip file at*https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Resource-library.html.

November 22, 2017