The objective of Medicare's new Merit-based Incentive Payment System (MIPS) is to improve the quality of care while reducing cost. A physician's costs will account for 10 percent of his or her total MIPS score in 2018; next year, it may account for 30 percent at the discretion of CMS. Physicians with the highest MIPS scores in 2018 will receive a positive payment adjustment in 2020, while those with low scores may receive a penalty of up to 5 percent of total Medicare pay that year. CMS calculates the score using Medicare Part A and Part B claims based on Medicare Spending Per Beneficiary and Total Per Capita Costs. Physicians can take certain steps to enhance their MIPS cost score, says Eric Cheng, MD, MS, FAAN, at the David Geffen School of Medicine. This includes checking Medicare's Physician Compare website to ensure they are not misclassified and providing proactive preventive care that reduces avoidable hospitalizations. This can include preventing a patient with a seizure disorder from needing an emergency department visit or preventing a multiple sclerosis patient from falling. "Those types of things are super-costly and they really add up," Cheng says. CMS will also consider comorbid conditions that add to the complexity of patient's care, which is where its Hierarchical Condition Category codes come into play.