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MIPS Essentials for 2021
2021 marks the fifth year of the traditional Merit-based Incentive Payment System (MIPS). Although the Centers for Medicare & Medicaid Services (CMS) worked to limit program changes given the COVID-19 pandemic, this year — like past years — sees multiple moving targets.
Key 2021 Program Updates
We summarize below the most significant additions and modifications that will impact practice reporting needs and, ultimately, reimbursement.
Other Program Changes for 2021
Penalty avoidance performance threshold. This threshold, which is the performance sum of the categories listed in the above table, is changing from 45 to 60 points. Since this is a big jump, it’s crucial that you perform as well as possible for each measure available to your specialty. The maximum penalty for underperformance remains at 9 percent, so it is as important as ever to work to avoid the penalty to protect your reimbursements and potentially earn increases.
Bonus points. Additional bonus points are still available in 2021 to small practices (15 or fewer eligible clinicians) and/or practices with “complex patients,” as defined by CMS. These bonuses will be automatically applied. Of note, for performance year (PY) 2020 only, due to the COVID-19 public health emergency, the complex bonus amount will be doubled, up to a maximum 10 points.
Staying the Same
While each new year brings changes to the MIPS program, some aspects will remain the same in 2021. Here are a few:
Targeted review of MIPS scores. This will continue in 2021, so if you disagree with your PY 2020 MIPS score, you can apply for a review within 60 days of the MIPS payment adjustment factor being released. Start watching for this option in late summer.
Exception applications. Applications for the small practice 2021 Promoting Interoperability Hardship Exception are still due by Dec. 31, 2021. The PY 2020 MIPS Program Extreme and Uncontrollable Circumstances Exception deadline has been extended to Feb. 1, 2021. Both applications are on the Quality Payment Program (QPP) website.
Using AAO’s IRIS Registry as Your MIPS Platform
While there are platforms that offer MIPS program support, the American Academy of Ophthalmology (AAO)’s Intelligent Research in Sight (IRIS) Registry remains a preferred platform for ophthalmic practices. If you participate in the IRIS Registry, you should have received your new representative’s contact information from Verana Health (IRIS’s new management vendor) in 2020.
IRIS anticipates continuing to test new measures for future scoring. Using these newer qualified clinical data registry (QCDR) measures for testing may earn you additional points. Perhaps most valuable, the IRIS Registry will, at the time of attestation, review your performance across all quality measures and submit the most advantageous score for you or your group.
Continue to Do Your Best
For the fifth year of the program, the traditional MIPS bar has been set at a significantly higher level. Meaningful participation requires, at minimum, monthly attention within the practice. Participate with your best effort while staying aligned with your practice’s focus and activities. Generating sensible reporting should be just another operational practice — one that easily integrates into your mission to always do the best you can for your practice.
NEED HELP? Contact our billing, coding and compliance team at 1-800-720-9667 or CodingandCompliance@bsmconsulting.com.