Do Physician Groups Get Bonuses for Submitting eCQM Measures?

Physicians and clinicians do not earn bonus points for submitting Electronic Clinical Quality Measures (eCQMs) as part of their annual MIPS reporting to CMS. However, there are three MIPS program bonus point opportunities that physicians and clinicians may qualify for: the Improvement Bonus, the Complex Patient Bonus, and the Small Practice Bonus.

What is the Improvement Bonus in MIPS?

Requirements for the Merit-Based Incentive Payment System (MIPS) program are divided into four categories: Quality, Promoting Interoperability, Improvement Activities, and Cost.

The MIPS Improvement Bonus allows physicians and clinicians to earn extra percentage points for demonstrating year-over-year improvement to their Quality category score, provided that there is enough data from the previous year for comparison. How many bonus points you can earn is determined by how significantly you improved, with 10 percentage points being the maximum.

Physicians and clinicians can also earn up to 1 extra point for improving their performance in the Cost category year over year.

What is the Complex Patient Bonus?

Physicians and clinicians can earn up to 5 bonus points under the MIPS Complex Patient Bonus. This bonus is designed to level the playing field so that clinicians who serve a more challenging patient population are not unduly penalized.

The Complex Patient Bonus is calculated by looking at two factors: your average Hierarchical Condition Categories (HCC) risk score and the number of dual-eligible patients (eligible for both Medicare and Medicaid) that you treated. To learn more, download CMS’s Complex Patient Bonus fact sheet.

How do you qualify for the Small Practice Bonus?

You may qualify for the MIPS Small Practice Bonus if you have 15 or fewer MIPS-eligible clinicians in your practice. Qualifying practices receive an additional six bonus points to the numerator that is used to calculate their Quality category score. If, for example, the numerator and denominator for a small practice totals up to 50 and 60 points respectively, the bonus will be applied to the 50-point numerator: (50 +6) / 60

MIPS bonuses can change annually

Keep in mind that CMS updates the MIPS program each year, and everything from eCQM requirements to available bonuses to how the categories are scored is subject to change. For the latest MIPS and QPP updates, please consult the Medisolv Education Center or visit CMS’s Quality Payment Program site.

Score higher on your next MIPS submission

Medisolv can help. We combine the industry’s best MIPS management software with unparalleled Clinical Quality Advisor support to help you improve your MIPS performance and payouts year after year. Schedule an introductory call with us today to get peace of mind before your next submission.