MIPS Data Completeness Requirement

The Medicare guidelines require a Patient Reported Outcome (PRO) measure be provisioned on a defined percentage of all patients eligible for the corresponding PRO measure(s) and who do not have any exclusions. To establish a patient's eligibility, one of the MIPS Qualification forms (MIPS Qualification Clinic Form or the Pre-Visit Patient Form) must be completed for every initial evaluation a patient attends.  

Quality Scoring: Data Completeness Requirement by Year

2020: A minimum of 70% data completeness is required to achieve the maximum points for each measure.

When is a patient excluded from completing a MIPS PRO?

If a patient has an exclusion they will NOT count towards the minimum reporting requirements. Possible exclusions include:

    1. Patients will be automatically excluded from MIPS submission if they:

      • Are under the age of 18 years old

      • Are not under treatment related to one of the 5 CMS-approved measures (LEFS, MDQ, NDI, KOS, QDASH)

      • Do not complete 2 or more forms for an assigned measure

    2. Additionally, patients can manually be excluded (disqualified) from MIPS if they:

      • Are non-English speaking and translation services are unavailable

      • Are unable to read

      • Unable to accurately complete the MIPS PRO due to a mental or cognitive impairment

      • Patients meeting medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

      • Are determined to be extremely medical complex and likely to make poor clinical progress based on the experience and clinical judgment of the treating clinician