Understanding MIPS Reporting in 2020

The Impact of COVID-19 on MIPS Reporting

The year 2020 has taught us the importance of navigating uncertainty, particularly highlighted by the COVID-19 pandemic. This health crisis created significant challenges, affecting various sectors, including the QPP MIPS reporting program for 2019. The pandemic forced delays as healthcare professionals, doctors, and suppliers grappled with overwhelming demands. Consequently, the submission deadline for MIPS 2019 was extended by a month to accommodate clinicians focused on the surge of COVID-19 cases.

MIPS 2020 Reporting Requirements

Despite the challenges posed by the pandemic, MIPS 2020 reporting remains active. Clinicians must submit data as individuals, groups, or virtual groups to qualify for positive payment adjustments. To secure incentives, a score above 45 is essential. Unlike previous years, MIPS 2020 mandates data submissions across all reportable categories to avoid negative payment adjustments. Typically, physicians utilize a MIPS Qualified Registry to submit their data, but relying solely on Quality measures will not suffice for achieving a score above 45.

Steps for Successful MIPS Reporting

Check Your Participation Status

Before initiating MIPS 2020 reporting, verifying your eligibility is crucial. Certain surgeons may qualify for special statuses that provide additional benefits. By including your NPI, you can access your participation status. Surgeons with special statuses may earn bonus points and have their reporting categories reweighted. Additionally, physicians can outsource MIPS 2020 reporting to a MIPS Qualified Registry, which will assist in checking eligibility and gathering necessary information.

Selecting MIPS Quality Measures

When it comes to Quality measures, careful selection is vital. Choose measures with benchmarks that maximize your scoring potential. For instance, many surgery-driven measures are topped-out, yielding a maximum of 7 points. This might encourage you to explore other measures, such as outcome measures or high-priority measures, that could offer bonus points. A MIPS Qualified Registry can streamline this selection process by analyzing your expertise and recommending suitable measures.

Engagement in COVID-19 Clinical Trials as Improvement Activity

The COVID-19 pandemic has presented numerous challenges, but it has also opened avenues for scoring opportunities within MIPS 2020. A new high-weighted COVID-19 clinical trial activity has been introduced, contributing to the total scores for eligible clinicians. This not only provides a chance for higher scores but also allows clinicians to gain recognition for their contributions to COVID-19 research. Clinicians can earn credit by participating in a COVID clinical trial or by submitting clinical data from COVID patient care to a clinical data registry. The National Institutes of Health (NIH) oversees the COVID-19 clinical trials, serving as a starting point for participation.

Scoring Considerations for Clinicians

Scoring Cases for Clinicians with Special Statuses

In the context of scoring, the cost category is excluded from the examples due to its reliance on complex claims data. For clinicians eligible for PI exemptions, 25% of the PI category weight is transferred into Quality, raising its weight to 70% of the total score. For example, achieving 26 measure points in Quality equates to approximately 30 MIPS points, plus 15 points for a complete IA submission, totaling 45 points.

Scoring for Physician Groups

For physician groups consisting of 15 or fewer members, reporting at least one Quality measure results in six bonus points in the Quality category. In this case, 20 measure points plus 6 bonus points yield around 30 MIPS points, again adding 15 points for a complete IA submission, resulting in 45 MIPS points.

Recommendations from the American College of Surgeons

The American College of Surgeons advises that a score of 45 is the safest target for MIPS 2020 submissions to avoid penalties in the payment year 2022, regardless of the reporting method. They recommend specific strategies to enhance scoring and facilitate compliance with the program. Importantly, there are no changes to eligibility status and opt-in determinations, ensuring clarity amid the ongoing COVID situation.

Conclusion

Although the threshold for MIPS reporting has become more challenging, clinicians who prepare adequately and select appropriate specialty-specific measures can demonstrate exceptional performance. This program ultimately serves as an incentive for clinicians to enhance the quality of care they provide. For those needing assistance, MIPS consultants are available to support performance improvement efforts.