MIPS 2021 - What's New?

Noelle Johnson

With the health care landscape continuing to be impacted by the COVID-19 pandemic, the Merit Incentive Payment System Program (MIPS) has also continued to evolve. The Centers for Medicare and Medicaid (CMS) has released updates to the program that are being implemented for MIPS Year 5. With patient care and safety being the top priority, the pMD team continues to closely follow the changes and keep you up-to-date.

As a qualified MIPS registry, pMD has been keeping an eye on the changes and requirements for reporting in 2021. We continue to offer our customers the tools to submit their 2021 MIPS data to CMS and navigate some of these changes using our robust dashboard and being in close contact with our excellent account management team.

Interested in what has changed for 2021 MIPS? Please review the updates below. A full list of changes to the Year 5 Final Rule and the most up-to-date information can be found on the Quality Payment Program (QPP) website.

Reporting Requirements

If your practice is unsure of your reporting requirements, the QPP has a readily available tool for determining your eligibility. The QPP Participation Lookup tool provides insight into provider eligibility as well as special status. To review your 2021 eligibility, simply enter your NPI into the tool and review!

Scoring Requirements

CMS has increased the data requirements and score requirements for 2021 MIPS:

  1. Quality measures must meet 70% of data completeness this year.
  2. Improvement Activities must apply to 50% or more physicians within a group to attest.
  3. The performance threshold has been raised to 60 points to avoid a penalty and 85 points to get an exceptional performance bonus.  

There also have been changes to performance category weighting for 2021 MIPS:

  1. The Quality performance category will be weighted at 40% (5% decrease).
  2. The Cost performance category will be weighted at 20% (5% increase).

Promoting Interoperability will be weighted at 25% and Improvement Activities will be weighted at 15% - these are the same weightings as 2020.

Avoiding the Penalty

With the minimum required score increasing substantially, CMS lists guidelines that will help your practice avoid the penalty:

  1. Groups should submit a combination of quality measures, Improvement Activities, and/or Promoting Interoperability. Groups can review 2021 measures on the QPP site.
  2. Groups should submit 6 clinically relevant quality measures. At least 1 of these measures should be a high-priority or outcome measure.
  3. If your group does not have 6 clinically relevant measures selected, you will be required to submit a specialty measure set.

Bonus Points

Certain practices and measure selections can help your practice earn bonus points. You can earn bonus points by doing the following: 1) Submit 2 or more outcome or high-priority quality measures.2) Small practices that submit at least 1 measure can earn six bonus points for the quality performance category score. 3) Practices can earn up to 10 bonus points if their quality performance category score improves. We are accepting new practices to report MIPS with us in 2022. If you are interested in learning more, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you!

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealth, and secure communication software and services, please contact pMD.

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