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Cost Requirements

Cost is an important part of MIPS because it measures resources that clinicians use to care for patients and the Medicare payments for care (items and services) given to a beneficiary during an episode of care.

Requirements may change each Performance Year (PY) due to shifting rules.

2017 Cost Measures Requirements

0% of final score

Cost does not count toward your final score for Performance Year 2017, but you will still be evaluated on the measures to help you understand your performance.

What Cost Data Should I Submit?

All participants will be evaluated on the same cost measures, though some clinicians and groups will not have enough attributed patients to be evaluated on all measures.

View Cost Measures

Explore the 2017 cost measures.

Explore Measures

How Should I Submit Data?

There is no data submission requirement for the cost performance category. Cost measures are evaluated automatically through administrative claims data.

2018 Cost Requirements

10% of final score

This percentage can change due to APM participation and the volume of attributed patients. In the event that there are not enough attributed beneficiaries for the Medicare Spending Per Beneficiary (MSPB)  and Total per Capita Cost (TPC) measures, the Cost performance category weight will be added to the Quality performance category.

For 2018, MIPS uses cost measures that cover the total cost of care during the year or during a hospital stay.

What Cost Data Should I Submit?

All participants will be evaluated on the same two cost measures, though some clinicians and groups will not have enough attributed patients to be evaluated on both (or either) measures.

For 2018, MIPS uses cost measures that cover the total cost of care during the year or during a hospital stay.

View Cost Measures

Explore the 2018 cost measures.

Explore Measures

How Should I Submit Data?

There is no data submission requirement for the cost performance category. Cost measures are evaluated automatically through administrative claims data.


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