December 27, 2019

The Changes to MIPS in 2020

Recently, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule for the Quality Payment Program (QPP) in 2020. This update has numerous changes to MIPS in the coming year, as well as some future reporting years. What does your medical practice need to know before the 2020 year begins?

Higher Performance Threshold

Performance Threshold is the minimum number of MIPS points necessary to report/score, in order to avoid a penalty (negative payment adjustment). In 2020:

  • CMS has increased the performance threshold for doctor’s offices to 45 points, which is an increase over 30 point from the 2019 threshold.
  • A minimum score of 45 points, and up to 100 points, will have an increase in fee schedule, anywhere from zero to 9%.
  • Please note, there’s also an increase for the exceptional performance threshold. The minimum to be eligible for the exceptional bonus is 85 MIPS points in 2020.
  • If you choose not to report in 2020, or report below the threshold, the negative payment adjustment will be anywhere from zero to -9% in your fee schedule!

Performance Categories

The MIPS category weights are staying the same in 2020 [45% quality, 15% cost, 25% promoting interoperability (PI), 15% improvement activities (IA)]. CMS did indicate that those categories might be altered before 2021 begins.

Quality- Category weight 45%; Performance period: 365 days

CMS is also increasing the data completeness requirements from 60% to 70%. Your quality measures will need to be reported for at least 70% of claims for Medicare and non-Medicare patients over the course of the year. If you submit measures but they do not meet the requirements for the data completeness threshold, you will receive 0 points instead of 1.

Cost- Category weight 15%; Performance period: 365 days

CMS will maintain the existing 8 episode-based measures and add 10 new episode-based measures in 2020.

Improvement Activities (IA)- Category weight 15%; Performance period: 90 days

In the past, some practices relied on one main clinician to attest for the group. However, in 2020, at least 50% of your group must attest to completing the same improvement activity for 90 consecutive days. There are also some changes to the IA categories in 2020- 2 new, 7 existing modified, and 15 removed. Please look into this for your practice or reach out to a MIPS consultant.

Promoting Interoperability- Category weight 25%; Performance period: 90 days

In 2020:

  • CMS is including Query of Prescription Drug Monitoring Program (PDMP)- as an optional measure.
  • CMS is removing Verify Opioid Treatment Agreement, as a measure.
  • If you want this category to be reweighed, it is now 75% of your group that must meet the hospital-based clinician definition, instead of 100% in 2019.

Looking Ahead

While many of the most notable changes to MIPS in 2020 are summarized above, there are big changes on the way in 2021. CMS has announced that it will adopt an entirely new framework for the MIPS program starting with the 2021 performance year. This program will be called the MIPS Value Pathways, and it will enable doctors to report on a smaller set of specialty-specific and outcome-based measures. CMS hopes that this adjustment will allow doctors to move to an aligned set of measures that make sense with their scope of practice instead of a more general, comprehensive set.

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Medical Business Partners collaborates with your practice to ease the administrative burden on your practice and figure out ways to increase your revenues. Medical Business Partners performs coding audits with educational sessions, leads trainings and boot camps for staff and physicians, and analyzes ways to improve cash flow and billing operations. To learn more about their coding and billing services, start-up consulting, credentialing services or other ways they can help you increase your revenues, please contact us through their website or by calling (202) 390-3966.

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