MIPS Cost scores are coming — what to know for 2024 and prepping for 2025

If you’re an eligible clinician participating in MIPS, your 2024 Cost category score will be calculated after submission — and the results may come as a surprise. With Cost accounting for 30% of your total MIPS score, it’s no longer an afterthought. It’s a major factor in your final performance. 

But here’s the good news: Now is the time to learn from your prior years’ scores and take action to improve for 2025. With new scoring methodologies, expanded cost measures, and a growing emphasis on value-based care, understanding and optimizing Cost performance is critical to maximizing your Medicare reimbursement. 

What to expect when your 2024 Cost score arrives 

Unlike other MIPS categories where you report data, Cost is calculated entirely by CMS using claims data. That means providers don’t get feedback until after submission. Many clinicians are caught off-guard when they see their final scores, especially with the changes CMS has implemented for 2024 and 2025. 

Key changes that impact your 2024 score 

New median-based scoring: What it means for you 

Historically, MIPS Cost scoring was based on percentile rankings, which meant your score was determined relative to other providers. This often unfairly penalized clinicians whose costs were close to the median, even if they were providing efficient care. 

What’s changing? 

Median-based scoring 

• Instead of percentile rankings, CMS now sets the median cost at 7.5 points out of 10. 
• The score for each provider is calculated based on how far their costs deviate from the median using standard deviations.

Standard deviation-based adjustments 

• Providers whose costs are closer to the median will receive scores closer to 7.5, even if they aren’t among the lowest-cost providers.
   
• The further a provider’s costs deviate from the median (higher or lower), the greater the impact on their score.
  
  
• If a provider’s costs are significantly lower than the median, they may achieve a perfect 10.
  
  
• Conversely, if their costs are significantly higher, they may see their score drop below 7.5, potentially impacting their overall MIPS performance.

Changes to scoring for 2024 and 2025 

 Example change in scoring cost measure 
 
 

Why this matters 

More fair and predictable scoring 

• The previous percentile-based approach led to extreme score variations that didn’t always reflect a provider’s actual efficiency. 

• With the new method, scores are more stable and predictable, giving clinicians a better understanding of where they stand and how to improve. 

Reduced penalties for providers near the median 

• Under the old system, providers with costs close to the median could receive low scores simply because they weren’t among the lowest-cost providers. 

• Now, those same providers will score closer to 7.5, ensuring that cost-efficient care isn’t unfairly penalized. 

More emphasis on managing costs beyond the median 

• Since standard deviations dictate the score, providers at the extreme ends of cost variation will see the biggest impact.
  
  
• High-cost providers will need to focus on cost reduction strategies to avoid penalties. 
  
  
• Low-cost providers have an opportunity to maximize their scores and secure bonus incentives. 

Opportunities for cost improvement bonuses 

• If a provider improves their cost performance from the previous year, they can receive a Cost improvement score of up to 1% added to their total Cost measure achievement points.

What this means for 2025: Time to act 

By the time you receive your 2024 Cost score, it will be too late to make changes for that performance year. But what you learn from your score can help you take proactive steps to improve your Cost performance in 2025. 

3 steps to get ahead for 2025 

Analyze your prior Cost category scores 

• Identify which cost measures you were assessed on. 

• Review cost drivers and compare your performance to benchmarks. 

Optimize cost management strategies 

• Reduce avoidable hospitalizations, ER visits, and unnecessary tests. 

• Strengthen care coordination and follow-up strategies to prevent high-cost complications. 

Leverage technology and analytics 

• Use real-time MIPS analytics tools to track cost trends before it’s too late. 

• Partner with Healthmonix to gain actionable insights and improve performance.

Stay ahead with Healthmonix 

Your 2024 Cost score is just the beginning — it’s your roadmap for success in 2025. With new scoring rules and evolving cost measures, clinicians who take a data-driven approach will have the advantage. Work with us to see a prediction of your score so you can get started now. 

At Healthmonix, we help providers navigate MIPS changes, monitor cost performance, and optimize scores. Contact us today to learn how we can help you get ahead for 2025 and maximize your Medicare reimbursement.