CMS Changes Scoring for Cost Category in 2020 for Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) last week announced that all eligible MIPS providers will automatically receive re-weighting of the Cost category from 15% to 0% in their 2020 final calculation, regardless of their status in MIPS as an individual, group or virtual group, or their participation in an APM Entity.  CMS did not give a specific reason in their announcement on the QPP main webpage, but this relaxation is most likely due to the impact of COVID-19 on providers in 2020.  No change to 2021 reporting for this category has been made at this time.

As a reminder, the weights of the four categories before and after this announcement are shown below.  Unlike some other re-weighting in the past, this 15% change is split between the Quality (10% increase) and Program Interoperability (5% increase) areas.

  Quality Cost Improvement Activities Program Interoperability
2020 Before 45% 15% 15% 25%
2020 Now 55% 0% 15% 30%


If a practice has other re-weighting from hardship exceptions, CMS notes that those remain in effect and this split from Cost re-weighting is additive.

We are available and happy to assist you with issues related to eye care coding and reimbursement.  We are still giving our webinars related to Year 5 MIPS reporting and the significant changes for 2021 Evaluation and Management eye exam coding.  Our 2021 EM full program includes a large, completely revised text and new Office Visit Guide pocket guides.  We also have new webinars available to help you document these new E/M services as well as internally audit the 2021 E/M and Eye coding, so contact us if you are interested.  Stay safe. (800) 399-6565


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