If an individual or group’s final MIPS score is 70 or above, that will qualify for an exceptional performance bonus. There are separate funds set aside for this bonus, and it is not subject to budget neutrality requirements. CMS will make this determination based on all the data submitted. However, physicians would need to fully participate in more than one performance category and the best way to ensure that their performance is high is by participating for a year (or as close to a year as possible). Ophthalmologists are well-positioned to reach this threshold, due to the availability of several outcome measures in the Quality category, additional bonuses for electronic reporting, and available improvement activities, to name a few. Since CMS has made it very easy to avoid a penalty for the first year of MIPS, there is likely not going to be much money collected from penalties to re-distribute as bonuses for providers who score above the threshold. Aiming for 70 points in the final MIPS score to achieve the exceptional performance bonus is the only way to guarantee a bonus in 2019.