How do I read the CMS Individual Measure Specifications Manual?

Use the following outline to determine how to read the specifications.

Denominator Data

Eligible Instances: The number of instances (patients, visits, episodes, etc.) that meet all eligibility criteria for a specific measure of interest, as explained in the 2018 Measure Specifications Manual for Individual Measures.

Example of a measure denominator description, from the 2018 MIPS Registry Measure Specifications Manual:

  • Measure #12 (NQF 0086): Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation

Numerator Data

The numerator must detail the clinical quality action expected that satisfies the condition(s) and is the focus of the measurement for each patient, procedure or event established by the denominator. The numerator options are “MET” and “NOT MET” for all measures with some measures having the additional option of “DENOMINATOR EXCEPTION”. Under “Numerator” in the 2018 Measure Specifications Manual, the options will be separated by “OR”.

Performance Met: The number of eligible instances that meet the “MET” criteria.

Performance Denominator Exception: The number of eligible instances that meet the “DENOMINATOR EXCEPTION” criteria. *This does not apply to every measure.

Performance Not Met: The number of eligible instances that meet the “NOT MET” criteria.

Posted in: Merit-Based Incentive Program (MIPS)