CMS Announces QPP MIPS 2019 Performance Scores

Review Access for Clinicians

In the final quarter of 2020, the Centers for Medicare & Medicaid Services (CMS) released the performance scores for clinicians participating in the Quality Payment Program (QPP) MIPS for 2019 on their official website. Clinicians can access and review their MIPS 2019 scores through a secure portal designated for them. These scores, along with participation in MIPS 2020 reporting, will contribute to their revenue in the upcoming periods.

Understanding Payment Adjustments

Typically, performance scores indicate the percentage by which clinicians may receive positive, negative, or neutral payment adjustments. For 2019, these adjustments will be applied in 2021, setting the stage for potential incentives in 2022.

Review Window for MIPS 2019 Performance Score

Deadline for Score Challenges

The deadline to check and contest MIPS 2019 performance scores was October 5, 2020. During this timeframe, individuals, groups, virtual groups, and Alternative Payment Model (APM) participants could request a review of their scores if there were discrepancies.

Review Process Simplified

No special requirements were necessary to review the data; clinicians could use the same credentials submitted for data entry. This option provided a straightforward method for obtaining feedback. Additionally, due to the pandemic, CMS implemented a policy to prevent penalties for physicians who were unable to submit data in the previous year. For those who submitted data through a MIPS Qualified Registry, feedback could be reviewed on their behalf.

Key Points for Performance Review

Understanding QPP MIPS Incentives

QPP MIPS serves as an incentive payment model aimed at promoting high-quality healthcare services recognized and rewarded by CMS. The performance review period allows clinicians to verify the accuracy of their submitted data.

Predicting Final Scores

Physicians who submit MIPS data through a Qualified Registry often have an insight into their final scores. These registries utilize resources and a structured approach to report quality measures, enabling them to predict scores effectively. This method alleviates the stress of data submission, allowing clinicians to focus on maximizing their performance.

Common Review Scenarios

During the review of MIPS performance scores, clinicians may encounter several situations, including:
– Errors or loss of quality data in submitted performance measures.
– Eligibility and special status issues, such as low-volume threshold performance.
– Non-inclusion in APM participation, which may affect review outcomes.
– Lack of reweighting in performance categories despite qualifying for automatic reweighting under CMS’s extreme and uncontrollable circumstances clause.

Relaxations for QPP MIPS 2020 Data Submission

Adapting to COVID-19 Challenges

The COVID-19 pandemic has placed immense pressure on the healthcare system, making it challenging for doctors to compile necessary data according to CMS requirements. To alleviate this burden, CMS has offered flexibility in the reporting process. The option to apply for “Extreme and Uncontrollable Conditions” remained available until December 31, 2020. However, the deadline for MIPS 2020 submission is still forthcoming.

Support for Non-Compliant Practices

Practices that are eligible yet non-compliant may benefit from assistance through P3, which can submit on their behalf. This support helps avoid a 9% penalty while enhancing the chances of receiving a 5% MIPS incentive.

Flexible Reporting Options

Response from the AMA

The American Medical Association (AMA) has urged CMS to provide flexible reporting options for QPP MIPS and other incentive payment models. Eligible physicians may choose not to be scored on “Cost” and “Quality” measures. In such cases, CMS will only evaluate their performance based on “Improvement Activities (IA)” and “Promoting Interoperability (PI)” categories.

Future Expectations

Collaboration for Improvement

CMS is collaborating with the AMA to address challenges related to QPP MIPS data submission amid the COVID-19 pandemic. Stakeholders in the healthcare industry can anticipate enhancements in Medicare payments and more flexible regulatory guidelines. The outcome for MIPS 2020 and subsequent years remains to be seen.