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Quality Payment Program (QPP) Support Center

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2018 MIPS Cost Tip of the Day


The cost category is worth 10% of the total MIPS score in 2018 and is based on two cost measures:  Medicare Spending Per Beneficiary (MSPB) and Total Per Capita Cost (TPCC).  These measures are based on a full calendar year of Medicare Part A and Part B claims and payments, so clinicians and practices do not need to submit any data for this MIPS performance category.

Cost Measure #1: MSPB: Calculated from Medicare payments for services performed by a clinician or TIN during a MSPB episode which includes three days prior to an episode, 30 days post a hospital stay, and the episode itself.

Cost Measure #2: TPCC: Calculated from Medicare Part A and Part B claims based on patients’ attribution to one clinician or TIN using the level of primary care services that were received and the clinician specialty that performed the services.

There are two things you can do NOW to help improve cost measure rates. The first thing is to become familiar with your data. Review your 2016 Quality and Resource Use Report (QRUR). 2016 is the most recent and final QRUR. For 2017, you can review your cost category score in the QPP Feedback report. Unfortunately detailed data is not available for 2017 because this category was not included in the 2017 MIPS score. Be sure to compare your performance to the national average.