Medicare Compliance & Reimbursement

Mastering the Merit-Based Incentive Payment System (MIPS) policies is no easy task. The feds change things up often with frequent updates and new requirements — that are tied to your Medicare incentive pay.

That’s why it’s important to review the different parts to see if you’re up to speed. From the four distinct categories to the complicated timelines to the changing measures, MIPS is a lot to handle.

This issue we’re looking at the Cost performance category with our second quiz in our Quality Payment Program (QPP) testing series. Read on to see how much you know about Cost.

1. What is the primary purpose of the Cost performance category?

a. Measure how well a provider balances healthcare expense

b. Assess how expensive a service is

c. Calculate how much to charge for certain services

d. None of the above

2. For the 2024 performance year/2026 payment year, what weight does the Cost category carry of the total MIPS score?

a. 0 percent

b. 15 percent

c. 30 percent

d. 45 percent

3. How many Cost measures are there for PY 2024?

a. 25

b. 27

c. 29

d. 31

4. What are the two Cost measure types?

a. Acute-based and outpatient

b. Episode-based and population-based

c. Inpatient and outpatient

d. Public-based and private-based

5. What is a Cost measure option for PY 2024?

a. Total Per Capita Cost for All Attributed Beneficiaries (TPCC) measure

b. Medicare Spending Per Beneficiary (MSPB) measure

c. Emergency care-focused measure

d. All of the above

6. What is important to understand about episode-based measures under the Cost performance category?

a. They don’t count toward the total requirement

b. MIPS clinicians are scored on them based on their minimum case volume

c. MIPS providers use them to determine their maximum visit numbers

d. None of the above

7. What factors into the Medicare Spending Per Beneficiary (MSPB) measure?

a. The gender of the beneficiary

b. The total Part A and Part B costs attributed to a single patient by a provider or group during a specific period or episode timeframe

c. The age of the patient

d. The patient’s location

8. What does the Centers for Medicare & Medicaid Services (CMS) use to determine clinicians’ Cost measure performance?

a. Measure submissions

b. Administrative claims data

c. Previous MIPS data

d. The final MIPS score

9. If you’re a MIPS APM entity and you choose to report under Traditional MIPS, what is the Cost performance category weighted for you?

a. 0 percent

b. 15 percent

c. 30 percent

d. 45 percent

10. True or false: Every MIPS-eligible clinician, group, or virtual group can automatically utilize facility-based scoring whether or not they’re facility-based.

a. True

b. False

Answers: 1) a 2) c 3) c 4) b 5) d 6) b 7) b 8) b 9) a 10) b