4 Things Physicians Need to Know for Medicare Payment 2020

Payment plans and schedules are changed every year to accommodate changes and diverse situations. Talking about the Medicare Physician Payment Schedule 2020, it has also been modified to reduce the administrative burden in effect from 2021.

The codes have been revised for outpatient evaluation and management (E/M), and there is a lot of information that tells about tweaks in the details of how physicians will be paid for their services.

Given below are five important factors that physicians need to know. We will investigate them all through that how will they impact the Medicare Quality Payment Program (QPP). Ultimately, QPP MIPS 2020 participants and MIPS Qualified Registries can have an insight into what’s going to change and implement strategies accordingly.

Escaping from Penalty Requires Higher Margins

CMS (The Centers for Medicare and Medicaid Services) has set the bar very high for QPP MIPS 2020. This year, the minimum points to avoid a penalty are 45 points that were 30 points last year. In the upcoming year, it’s set for 60 points to be minimum. Moreover, the penalty percentage is also raised to 9% from 7%. The higher penalty threshold is expected to leave an impact on the cost parameter of the MIPS. However, statistics say that more clinicians are performing on the higher end of the score scale than on the lower end. Looking into MIPS 2018, CMS observed the average score was 86.9.

Exceptional Performance Threshold Goes High

CMS has a policy where exceptional performers in the MIPS can take part in the additional bonus pool of $500 million. At first, the exceptional performance was supposed to be 80 points, but in the final rule, it is set to be 85 points.

The high-performance threshold is surely high, and CMS states to reward the outstanding performers quite well. They have worked all year long with quality, consistency, and played with innovation so they deserve all the praise.

CMS estimates in MIPS 2020, 92.5% of the 880,000 MIPS-eligible clinicians will achieve more score than the penalty threshold and earn incentives. Moreover, they expect 45% of the total eligible physicians as high-performers.

Cost and Quality MIPS Performance Categories Remained Unchanged

CMS wished to lower the weight of quality category in 2020 from 45 to 40 points and raise the weight for cost from 15 to 20. But in the final rule, it all remained the same as the previous year.

The later decision was empowered by the AMA’s concerns that there are no detailed or timely feedback constraints for the cost category. Therefore, it wouldn’t be fair for physicians to increase the points of the cost parameter.

According to the CMS, they are in constant efforts to devising new rules for real-time data access for eligible clinicians to get a better understanding of these measures and their performance criteria. Moreover, it will also help them in keeping the cost factor in check.

CMS, however, plans to increase the weight of cost category only when eligible clinicians will be able to comprehend the data effectively based on performance feedback reports on episode-based measures.

AMA (American Medical Association) states that they are concerned over the cost measures as Medicare Spending per Beneficiary and Total Per Capita Cost as physicians have no control over them.

CMS believes that their approach will help to align incentives across the board.

Small medical practices via any MIPS data submission method can receive bonus points for treating patients with high-risk or complex medical conditions or for patients with double Medicare-Medicaid eligibility.

Administrative Burden is Cutting Down

CMS is moving ahead with a framework “MIPS Value Pathways”, starting from 2021 to counter the administrative issues and complexities that we hear associated with MIPS.

The four MIPS performance categories seem like different programs so CMS decides to replace with a pathway that:

• Aligns with eligible physicians’ specialties
• Includes lesser MIPS reporting measures
• Compatible to move towards advanced Alternative Payment Models (APMs)

AMA and CMS are working together to relive every stressful aspect of the MIPS, and we can expect fruitful outcomes in the future.

Promoting Interoperability Requirements in QPP MIPS 2020

Promoting Interoperability (PI) in QPP MIPS is all about technology incorporation in the healthcare industry to empower patients and making information transmission easy. Certified electronic health record technology (CEHRT) is the most appreciated medium to achieve this.

Each year, CMS changes some of its requirements and policies to better facilitate physicians. In the performance year 2020, some of the requirements are also changed.

Here is an overview of everything related to promoting interoperability in MIPS 2020.

Final Score Percentage

This category has a total of 25 points in the final MIPS score.

Changes can be expected due to hardship exceptional applications and other special statuses, reweighting other categories.

What Data is to be submitted for this Category?

Eligible physicians are required to submit data and measures that translate the 2015 version of CEHRT.

PI has the following four objectives and the submitted data should translate these objectives.

What are the Requirements for PI QPP MIPS 2020?

2015 Edition CEHRT is the most important feature to participate in the ongoing MIPS year for PI. The data is to be submitted for consecutive ninety or more days with the following objectives unless there is an exception.

Alongside the related data, CMS requires the physicians’ EHR CMS Identification code from the Certified Health IT Product List (CHPL).

Moreover, physicians or MIPS Qualified Registries on their behalves must submit an affirmative response to the following categories.

·         The prevention of information blocking attestation

·         The ONC direct review confirmation

·         The security risk analysis

What are the Hardship Exceptions?

In case, eligible physicians are unable to report for this category, they can apply for the hardship exception for any of the following reasons.

·         If the clinician works in a small practice

·         If the clinician uses decertified EHR technology

·         No or Insufficient Internet connectivity

·         Extreme and uncontrollable circumstances

·         Lack of control over the availability of CEHRT

If the reason is accepted by the CMS, the weight of this category will be distributed to another category or categories (Quality, Improvement Activities (IA), & Cost), unless the stream less data submission.

Some types of clinicians such as physical therapists, occupational therapists, or clinical psychologists don’t need to apply for an exception for this category. They receive special status for QPP MIPS reporting; therefore, their percentage will automatically be reweighted.

Another requirement is that from groups or virtual groups, all participants must qualify for the reweight unless the group is exempted by a special status.

How to Submit Data?

For promoting interoperability performance year, there are three methods to submit data.

·         Attestation method via sign up

·         Upload data via sign up

·         Direct submission via API

However, the submission method depends upon the submitter type. The following table shows the details of the data submission.

Submitter Type	Sign up & Upload	Sign up & Upload	Direct Submission via API
MIPS eligible clinician	Allowed	Allowed	Not Allowed
Any representative on behalf of medical practice or virtual group	Allowed	Allowed	Not Allowed
Third-party Intermediaries	Not Allowed	Allowed	Allowed

How CMS Scores PI measures?

CMS scores every measure by multiplying the performance rate by the available points of the measure. The Public Health and Clinical Data Exchange awards full points if data is submitted for two registries or one registry with one exclusion.

Eligible clinicians should report all necessary required measures, i.e. submit data for at least one patient in the numerator, as applicable, or exclusion. Otherwise, clinicians can receive zero points.

If groups or eligible clinicians claim exclusions, points of those measures are reallocated to other measures.

How to Get Bonus Points?

If clinicians or MIPS Qualified Registries report data for the optional measure, Query of Prescription Drug Monitoring (PDMP), they can earn 5 bonus points in this category.

This is some of the information that clinicians need to know for reporting the promoting interoperability category in QPP MIPS. If you have participated for four years, you would be updated with the changes for MIPS 2020 reporting, otherwise, you can consult a MIPS Qualified Registry for maximum benefits. For more details, visit, https://qppmips.com/

You must be thinking that it is long before the MIPS 2020 reporting, we can start later on, but with the on-going crisis, clinicians who would start planning today would be benefitted more with accurate data submission and ultimately, more points.

QPP MIPS 2020 Guidelines for Chiropractors

QPP MIPS is a payment model that CMS (the Centers for Medicare & Medicaid Services) has established for high or reasonable performers in the healthcare industry. Eligible Medicare clinicians can report their data that translates quality healthcare, improvement activities, and interoperability while keeping the cost factor in control.

This payment program rewards physicians with positive payment adjustment, incentives, bonuses, and gives a penalty to those, who don’t meet even the basic performance threshold.

All participants must familiarize themselves with the deadlines and reporting criteria to maximize revenue in the end. There are many MIPS submission methods through the reporting process. However, the most preferable method by hospitals, clinicians, and groups is MIPS Qualified Registries.

Updates Related to MIPS 2020

Every year, CMS modifies some of its rules to accommodate changes or to reduce the administrative burden on physicians. On November 1, 2019, some updates were also released for the performance year 2020. New specialty sets were introduced including chiropractic medicine as part of the quality performance category.

Other updates are:

• Data completeness constraint is raised to seventy percent.
• The performance or penalty-free threshold is raised to forty-five points.
• Cost (15) and quality (45) performance categories have the same points as 2019.
• Moreover, MIPS Value Pathways (MVPs) has also been proposed that refers to the conceptual participation framework. It works to increase understanding and collaboration among physicians and offers measures that align more with the expertise of medical practice.

Given below are the measures that chiropractors can use to report their performance for MIPS 2020.

Quality Performance Category

Total points: 45 of the total MIPS score

Eligible physicians have to report 6 measures with one Outcome or High Priority measure for 12 months. Report at least one eligible case to earn 1 or 3 points on a measure. For more than 3 points on a measure, physicians can report at least 60 percent of eligible cases.

Some of the reporting measures for this category are:

• #182 Functional outcome assessment
• #131 Pain assessment prior to initiation of patient therapy and follow-up
• #218 Functional Status Change for Patients with Hip Impairments
• #219 Functional Status Change for Patients with Lower Leg, Foot or Ankle Impairments
• #220 Functional Status Change for Patients with Low Back Impairments
• #222 Functional Status Change for Patients with Elbow, Wrist or Hand Impairments
• #223 Functional Status Change for Patients with General Orthopedic Impairments
• #221 Functional Status Change for Patients with Shoulder Impairments
• #217 Functional Status Change for Patients with Knee Impairments

Promoting Interoperability (PI)

Total points: 25 of the total MIPS score

Eligible chiropractors are required to report all required measures for a minimum of 90 days. 2015 Edition certification must be in place by October 3, 2019.

Some exclusions are available for all eleven reporting measures. Physicians can check their eligibility status on QPP MIPS official website https://qpp.cms.gov/participation-lookup. If physicians are unable to report for this category, the score will be re-weighted to the quality category.

Some of the reporting measures for this category are:

• e-Prescribing
• The query of the Prescription Drug Monitoring Program (PDMP) (optional)
• Provide Patients Electronic Access to Their Health Information
• Support Electronic Referral Loops by Sending Health Information
• Support Electronic Referral Loops by Receiving and Incorporating Health Information
• Immunization Registry Reporting
• Syndromic Surveillance Reporting
• Electronic Case Reporting
• Public Health Registry Reporting
• Clinical Data Registry Reporting

Improvement Activities (IA)

Total points: 25 of the total MIPS score

Physicians should report 2 high-weighted activities or 4 medium-weighted activities for a minimum of 90 days. Groups with 15 or fewer participants or if you are in a rural area or health professional shortage facility, you can report 1 high-weighted or 2 medium-weighted measures for a minimum of 90 days.

A total of ninety possible measures are available to choose from.

Some of the reporting measures for this category are:

• IA_EPA_3 - Collection and use of patient experience and satisfaction data on access (medium-weighted).
• IA_BE_14 - Engage patients and families to guide improvement in the system of healthcare (medium-weighted).
• IA_CC_8 - Implementation of documentation improvements for practice/process improvements (medium weighted).
• IA_CC_2 - Implementation of improvements that contribute to cohesive communication of test results (medium-weighted).
• IA_BE_16 - Evidenced-based techniques to promote self-management into usual care (medium-weighted).
• IA_BE_17 - Use of tools to assist patient self-management (medium-weighted).
• IA_BE_21 - Improved Practices that Disseminate Appropriate Self-Management Materials (medium-weighted).
• IA_AHE_1 - Engagement of new Medicaid patients and follow-up (high weighted).
• IA_EPA_1 - Provide 24/7 access to clinicians/groups who have real-time access to the patient’s medical record (high weighted).
• IA_AHE_3 - Promote Use of Patient-Reported Outcome Tools (high weighted).

For further details on QPP MIPS data submission, contact - https://qppmips.com/ | (888) 902-1035