Daily Practice

MIPS APMs and ACOs

A practice may be part of an Alternative Payment Model (APM) called a “MIPS APM”.  MIPS APMs have MIPS eligible clinicians participating in the APM on their CMS-approved participation list. While this is an APM, the practice is not excluded from MIPS, but may be scored using a special APM scoring standard. Accountable Care Organizations (ACO) can also be categorized as MIPS APMs.

A practice can find out if they are connected to a MIPS APM using the QPP eligibility lookup.

Eligibility
Scoring Standard
MIPS APM and ACO models
Performance Category Action Required

Star_Quality

MSSP Web Interface measures reported through the ACO, using MSSP quality benchmarks. Earn up to 10 points per measure based on performance vs. benchmark. Bonus points are awarded for reporting high priority measures contained in the Web Interface measure set. Measures are averaged to compile a score for this category.

Max Possible Points: 210+ points
Percentage of Overall Score: 50%

Computer_ACI

Clinicians must report all 11 required Base Score measures to earn credit in this category. Additionally, clinicians must report on a select amount of measures of their choice under the Performance Score for up to 10 points per measure. One bonus point will be awarded for reporting an additional public health registry measure beyond the minimum required. Base Score, Performance Score and bonus points are totaled. Any total score over 100 points earns full credit in this category.

MSSP ACOs
All MIPS eligible clinicians participating in the APM Entity group will submit according to MIPS requirements. Performance will be assessed as a group through the billing TINs associated with the ACO for MSSP. All of the ACO participant group billing TIN scores will be aggregated as a weighted average to yield one ACO group score.

Next Generation ACOs
All MIPS eligible clinicians participating in the APM Entity group submit as individuals according to MIPS requirements. All of the MIPS eligible clinician scores will be aggregated and averaged to yield one ACO score. An ACO eligible clinician who does not report this category contributes a score of zero.

Max Possible Points: 100 points
(Base Score= 50 points
Performance Score= 80 points)

Percentage of Overall Score: 50%

Checklist_IA

Each clinician will be required to report one-to-three approved CPIAs to earn full credit in this category. Each activity is worth 10 points; however certain activities are worth 20 points for being considered “high value.” The clinician must earn at least 60 points to be awarded full credit in this category. ACOs will be given 30 points in this category automatically for their participation in the ACO.

Max Possible Points: 60 points
Percentage of Overall Score: 20%

Money_Cost

CMS will not calculate a cost score for ACOs under the MIPS APM Scoring Standard

Max Possible Points: N/A
Percentage of Overall Score: 0%

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