Clinical Quality Measures for
MIPS Reporting Period 2021
- Submit collected data for at least 6 measures, including 1 outcome or high-priority measure in absence of an applicable outcome measure, or a complete specialty measure set.
- If you choose to submit a specialty measure set, you must submit data on at least 6 measures within that set. If the set contains fewer than 6 measures, you should submit each measure in the set.
- Performance Period is for 12 months (January 1st – December 31st)
You can submit measures from different collection types (except CMS Web Interface measures) to fulfill the requirement to report a minimum of 6 quality measures.
- CMS Web Interface (Group of 25 or more) (NOTE: Will not be available for CY 2022 and beyond)
- eCQMs (Electronic Clinical Quality Measures)
- Medicare Part B Claims (Small Practice ONLY – defined as 15 or fewer)
- MIPS CQMs (MIPS Clinical Quality Measures)
- QCDR (Qualified Clinical Data Registry Measures)
There are 4 submission types you can use for quality measures:
- Medicare Part B Claims: Small Practice Only
- Sign-In and Upload
- CMS Web Interface: Group of 25 or more
- Direct submission via Application Programming Interface (API): For 25 or more clinicians and Third-party Intermediary
- 40% of Final Score (This percentage can change due to Exception Applications or APM Entity participation)
Scoring Policies for Quality Measures:
- Each measure submitted will be scored on a scale from 3-10 or 3-7 for Topped-out measures that meet all the following criteria: Has a benchmark; Meets Case Minimum (20); Meets Data Completeness (70%)
- Measures that are submitted and meet data completeness, BUT do not have either a benchmark or meets case minimum will be awarded 3 points
- Measures that are submitted BUT do not meet data completeness, even if the measure has a benchmark and/or meets the case minimum:
- Small Practice will receive 3 points for the measure
- Large Practice will receive 0 points for the measure
NOTE: Benchmarks are set from historical data (from 2 years prior). When a historical benchmark can’t be created, CMS will attempt to create a benchmark using data submitted for the performance period.
- Report on additional Outcome or High Priority measures beyond the required 1:
- Outcome measure = 2 bonus points
- High Priority measure = 1 bonus point
- Quality measures submitted thru EHR reporting
- 1 Point for each measure submitted
- Small Practice Bonus (15 EC or less)
- 6 bonus points will be added to the quality category for clinicians in small practices who submit at least 1 measure, either individually or as a group or virtual group. This bonus is not added to clinicians or groups who are scored under facility-based scoring.
- Will be based on the rate of improvement such that higher improvement results in more points for those who have not previously performed well.
- Improvement will be measured at the performance category level.
- Up to 10 percentage points available.
High Priority Measures
eCQM / NQF ID
7 Point Cap
|Closing the Referral Loop: Receipt of Specialist Report||CMS50v9 / None||Yes||No|
|Documentation of Current Medications in the Medical Record||CMS68v10 / 0419e||Yes||Yes|
|Functional Status Assessment for Congestive Heart Failure||CMS90v10 / None||Yes||No|
|Screening for Future Falls Risk||CMS139v9 / None||Yes||No|
|Appropriate Testing for Pharyngitis||CMS146v9 / None||Yes||No|
|Appropriate Treatment for Upper Respiratory Infection (URI)||CMS154v9 / None||Yes||No|
|Use of High-Risk Medications in Older Adults||CMS156v9 / None||Yes||Yes|