To determine and rate quality and cost measures based on administrative claims data, CMS has established the following approach for calculating and scoring these measures at the TIN level within the affiliate group, rather than at the subgroup level.
Foundational Layer: If a population health measure is chosen, subgroups will receive the corresponding group’s score, if it is accessible. If a group score is not available, that particular measure will be excluded from the overall quality performance category score.
Quality Performance Category: If an outcome-based administrative claims measure is selected, subgroups will receive the associated group’s score, if it exists. If a group score is not available, zero achievement points will be assigned to each measure in question
Cost Performance Category: If the affiliated group’s score for the cost measure(s) included in the subgroup’s selected MVP is available, the subgroups will receive that score. If the group score is not available, the cost measure(s) will be excluded from the subgroup’s cost performance category score.
The CMS will not provide a definitive score for a subgroup that registers but fails to submit data as a subgroup.