CMS is determined to lessen the administrative burden associated with participating in the Merit-based Incentive Payment System (MIPS) so that healthcare providers can focus on ensuring patients get the best quality of care.

Thus, the following changes were made for next year and are documented in the CY2021 Physician Fee Schedule (PFS) Final Rule:

1.         The performance threshold for 2021 will be 60 points instead of the 50 previously proposed points. So, the threshold is 15 points higher than the 2020 performance period threshold.

2.         Instead of in 2021, as initially planned, MIPS Value Pathways (MVPs) will be implemented in 2022.

3.         Third parties, such as Qualified Registries and Qualified Clinical Data Registries, will be under new guidance regarding remedial action, termination, and re-approval of participation. The aim is to improve the services clinicians receive from third parties and reduce reporting burdens.

4.         The complex patient bonus is raised to a 10-point maximum (from 5 points) for clinicians, groups, virtual groups, and Alternative Payment Model (APM) Entities for the 2020 performance period only. CMS brought in this policy to remove the extra task of treating complex patients during the COVID-19 public health emergency.

5.         ACOs and other APM Entities are allowed to use the Extreme and Uncontrollable Circumstances Reweighting Application to request reweighting of all MIPS performance categories, starting with the 2020 performance period. In cases where the request is approved, the APM Entity group gets a score equal to the performance threshold — even when data are submitted. While this new rule pertains to APM Entities only, the previously made policy pertains to individuals, groups, or virtual groups.

There are also other significant changes to the Quality Payment Program for the 2021 performance period that are covered in WCH Insights. Check it out!

Key Updates in MIPS Performance Categories:

•           Quality: The weighting for the Quality performance category in participants' final score will be 40%, which is lower than the 45% it had in the 2020 performance period. CMS also stated that it had gotten sufficient data for the 2019 performance period, which can be used to calculate historical benchmarks for the 2021 performance period. However, due to PHE concerns, CMS had previously proposed the use of performance period benchmarks, rather than historical benchmarks, to score Quality measures for the 2021 performance period.

•           Improvement Activities: CMS made new policies for the Annual Call for Activities, including flexibility for Agency-nominated Improvement Activities and an exception to the nomination period timeframe during a public health emergency.

•           Promoting Interoperability: CMS retained the Query of Prescription Drug Monitoring Program measure as optional. However, it increased its worth from 5 to 10 bonus points. CMS is also adding a new Health Information Exchange (HIE) Bi-Directional Exchange measure as optional, and it will be worth 40 points.

•           Cost: The weighting for the Cost performance category in participants' final score will be 20%, higher than the 15% it had in the 2020 performance period. Telehealth services directly applicable to existing episode-based cost measures and the total per capita cost (TPCC) measure have been included in the CMS' updates of existing measure specifications.

Just a quick reminder - apart from medical billing, credentialing, auditing, as well as some other services, WCH provides MIPS support, including assistance in choosing the performance measures under each category and assistance in collecting and submitting data. 

Do not wait! Contact Feruza Khaydarova, our MIPS and EHR advisor, at feruzak@wchsb.com or call 718-934-6714 ext 1311.

Source: https://qpp.cms.gov/resources/resource-library