QPP MIPS 2020 is officially over, and MIPS eligible clinicians such as Anesthesiologist, Cardiologists, Dermatologists, and others, can get started on the MIPS 2021.
There is no hurry in this matter, but it is better to
comprehend the program. It will help MIPS Qualified Registries to see what they
can offer to their clients. Moreover, clinicians can align their efforts as per
the value-based incentive program requirements.
What does the Final Rule MIPS 2021 Says?
The QPP MIPS 2021 holds many levels, and to perform well as per the criteria, we should know about all the aspects.
- MIPS Score Threshold
- Performance categories weights
- Minimum performance thresholds
- APM scoring requirements
- Hierarchy of MIPS 2021 scores
In this article, we would briefly go through each aspect to
get grip on our MIPS 2021 strategies. Let’s get into it.
MIPS Score 2021
We have observed four significant changes for MIPS 2021
reporting. The performance threshold and category weights are changed. However,
for this year, the corona pandemic has played a major role in administrating
changes.
Thus, the scoring hierarchy will reflect on the quality. It
is also to note that CMS (Centers for Medicare and Medicaid Services) has
withdrawn the APM scoring thresholds.
An Insight into Performance Thresholds
Minimum Performance Threshold
In MIPS 2021, the performance threshold is set to be at
sixty points. It means that eligible clinicians now have to score at least sixty
to avoid penalties. Moreover, if they want to earn MIPS incentives, they must
meet at least this performance threshold.
CMS suggested setting points at fifty points at first.
However, after analyzing the 2019 MIPS data, they realized that clinicians could
manage the performance threshold of sixty points easily.
Exceptional Performance Threshold
The threshold for exceptional performance does not change in
2021. It remained the same in 2020.
Clinicians must achieve eighty-five points in order to get
additional MIPS incentives and qualifications of a $500 million pool. The more points you have, the more incentives
you can get.
MIPS 2021 Category Weights
There are different MIPS reporting weights for different
reporting frameworks. However, with MIPS 2021, we have the following
percentages for the following changes.
For all eligible individuals, groups, and virtual groups, the performance weighs as follows.
- Quality category: 40%
- Promoting Interoperability (PI): 25%
- Improvement Activities (IA): 15%
- Cost category: 20%
We observe that the cost category has increased, and The quality category has decreased since last year. Whereas, PI and IA remained the
same.
It is expected that in 2022, CMS would balance both
categories (Cost and Quality) at 30%.
MIPS 2021 Scoring Hierarchy
The hierarchy will give an idea of what MIPS incentives to
expect from eligible clinicians.
Clinicians must have an idea of what to expect in MIPS
incentives in 2023.
There are four methods to participate in MIPS 2021 reporting
as an individual, group, virtual group, and APM entity.
The following table will give you an idea of what we want to
suggest here.
MIPS APM Participation |
Participation Status |
Participation Method |
Eligibility |
Participation Level |
No |
MIPS Participant |
Standard |
Yes |
Individual, Group, Virtual Group |
Yes |
MIPS APM Participation |
Standard |
Yes |
Individual, Group, Virtual Group*, APM Entity |
APP |
For the performance of the year 2021, the MIPS payment adjustment is set to be at nine percent, which can
be from -9 to +9.
In a real-time
scenario, the adjustments are lesser than the actual 9%. CMS suggests that it
can be up to 6.89% for clinicians who manage to receive 100 MIPS points. Here
is to remember that these points are not guaranteed but just an estimation. The
actual points are based on the submitted data by the MIPS eligible clinician or
the MIPS Qualified Registry on their behalf.
The ultimate goal is
to achieve budget neutrality.
Requirement Analysis
For MIPS eligible
clinicians to participate and be successful in the program, one must follow the
following low-threshold volume criteria.
Clinician must:
- Have equal or more than $90K in Part B allowed charges for covered healthcare services
- Provide healthcare to equal or more than 200 Part B enrolled beneficiaries
- Provide equal or more than 200 covered
professional care services under the Physician Fee Schedule (PFS)
From recent studies, we know that MIPS scores are above
average. Hence, the higher percentage of
qualifying clinicians, the lower percentage of incentives they receive! In
simple terms, the incentives are finite, and with more MIPS 2021 eligible
clinicians qualifying for the bonus, lesser money will be distributed among
all.