The Cost category replaces the Medicare Value Modifier Program for eligible clinicians. Cost is responsible for 15% of your final MIPS score.
Cost is made up of two measures:
- Medicare Spending Per Beneficiary (MSPB)—Evaluates Medicare Part A and B costs in the period immediately prior to, during, and following a patient’s hospital stay. This episode defined as 3 days prior to an inpatient hospitalization, the hospitalization itself, and 30 days after an inpatient hospitalization.Beneficiaries are attributed to the clinician that provided the plurality of all Part B services during the inpatient hospitalization, including the day of admission.
- Total Per Capita Cost (TPCC)—Evaluates all Medicare Part A and B costs associated with any
beneficiary over a year. This measure relies on a 2-step process that assigns a beneficiary to a single clinician based on the amount of primary care services received and the clinician specialties that perform these services.
While no additional reporting is necessary for the cost component of MIPS, AAPM&R has created a 2021 MIPS Cost Guide to help members understand how cost is attributed to their overall MIPS score.