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Reporting And Data

Quality Payment Program (QPP) & Merit-Based Incentive Payment System (MIPS)

Latest Update: August 11, 2020
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Reporting Information

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, created the Quality Payment Program (QPP). The QPP streamlined multiple quality programs under the Merit-based Incentive Payment System (MIPS) including existing payment programs that ended 12/31/18: (1) Physician Quality Reporting System (PQRS); (2) Value-based Payment Modifier (VBM); and (3) Medicare Electronic Health Record (EHR) Incentive Program. MIPS is intended to rewards clinicians for value over volume.

Responsible Party

Who Must Report?

If you haven't determined your eligibility status yet, use the QPP Lookup Tool. You can also learn more about how CMS determines eligibility and eligibility determination periods and snapshots.

METHOD I CAHS:

Under Method I, the CAH bills Medicare for facility services and clinicians’ professional services separately under the physician fee schedule (PFS). In this case, The Centers for Medicare & Medicaid Services (CMS) will not make MIPS adjustments to a CAH’s facility payment. However, clinicians providing services at Method I CAHs are subject to MIPS reporting requirements, and may receive MIPS adjustments to their professional services payments based on performance.

METHOD II CAHS:

Under Method II, the CAH bills Medicare for facility services and for the professional services of clinicians who have reassigned their billing rights to the CAH. However, clinicians providing services at a Method II CAH are not required to reassign billing rights to the CAH, and may continue to bill Medicare directly for their professional services under the PFS.

  • If a MIPS-eligible clinician does not reassign billing rights to a Method II CAH, the clinician will directly receive any payment adjustments due under MIPS. CMS will not make a MIPS payment adjustment to the CAH based on these clinicians’ performance.
  • However, payment adjustments for MIPS-eligible clinicians who have reassigned their billing rights to the Method II CAH will directly apply to professional services payments made to the CAH.

RURAL HEALTH CLINICS (RHCS) AND FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS):

MIPS payment adjustments do not apply to facility payments to RHCs and FQHCs. Clinicians providing items and services in RHCs or FQHCs and billing under those respective payment systems will not be required to participate in MIPS or be subject to MIPS payment adjustments. However, if the clinicians practicing in RHCs or FQHCs bill services under the PFS, they may be expected to participate in MIPS and subject to MIPS payment adjustments.

More information can be found here: https://www.aha.org/other-resources/2018-01-08-applicability-mips-rural-providers

Deadlines

When Do I Report?

The MIPS performance year begins on January 1 and ends on December 31 each year. Program participants must report data collected during one calendar year by March 31 of the following calendar year. For example, program participants who collected data in 2017 must report their data by March 31, 2018 to be eligible for a payment increase and to avoid a payment reduction in 2019. Learn more about performance years here: https://qpp.cms.gov/about/deadlines?py=2017

Method

How Do I Report?

Submit data yourself (Visit Portal Site button above) or with the help of a third party intermediary, such as a Qualified Registry or Qualified Clinical Data Registry (QCDR). To see the lists of CMS approved Qualified Registries and QCDRs, visit the QPP Resource Library.

Contact Information

Contact CMS
By Phone:
Monday - Friday 8 a.m - 8 p.m ET
1-866-288-8292 (TRS: 711)

By Email:

Benefit/Penalty

Why Should I Report?
Performance Period Also referred to as… Corresponding Payment Year Corresponding Adjustment
2017 2017 “Transition” Year 2019 + or – 4%
2018 Year 2 2020 + or – 5%
2019 Year 3 2021 + or – 7%
2020 Year 4 2020 + or – 9%

In 2021, your payments for Medicare Part B services will be adjusted up or down based on your 2019 MIPS final score, which is a composite score that can range from 0 to 100 points and is based on your scores in 4 performance categories:

  • Quality is weighted at 45% (down from 50% in 2018), meaning it can contribute up to 45 points to your 2019 MIPS final score.
  • Promoting interoperability (PI) is weighted at 25% (same as 2018). See "Promoting Interoperability Programs (PIP) & Electronic Health Records - Meaningful Use (EHR-MU)"
  • Improvement activities is weighted at 15% (same as 2018).
  • Cost is weighted at 15% (up from 10% in 2018). CMS states that it expects to continue boosting cost’s weight by 5%, and reducing quality’s weight by 5%, every year until they are each weighted at 30% of the final score. (Cost is required by statute to be weighted at 30% of the final score by performance year 2022.)

More information can be found here: https://www.aao.org/eyenet/article/mips-final-score-penalties-bonuses

Based on your 2020 MIPS final score, CMS will apply a payment adjustment to your 2022 Medicare Part B payments.

To avoid a payment penalty in 2022, you need a 2020 MIPS final score of at least 45 points (up from 30 points in 2019); to earn an exceptional performance bonus, you need to score at least 85 points (up from 75 points in 2019).

More information can be found here: https://www.aao.org/eyenet/article/mips-2020-bonuses-and-penalties

Authority

The legal mandate requiring reporting

Notes

Any other pertinent information

Originating Legislation: H.R.2 (2015)

DISCLAIMER
Although many of these requirements apply to individual medical professionals and other types of hospitals and health care facilities, the information is presented solely to support Critical Access Hospitals. The reporting requirements and legal mandates on this site are not an exhaustive list and Nevada Rural Hospital Partners, Inc. bears no responsibility or liability for any hospitals' or providers' failure to comply with Federal or State laws or regulations.