Requirements for MIPS reporting
Year three of the QPP MIPS rule continues to build upon the new quality reporting initiative. Here are some of the highlights however these are not intended to be all-inclusive and we recommend reviewing the respective category fact sheets and other CMS documentation for additional information:
- There are four performance categories in 2019. Points can be earned in each category and are added together to give you a final MIPS score however the value of each category toward your overall score has changed. The four MIPS categories are: Quality (45%); Cost (15%); Improvement Activities (15%) and Advancing Care Information (25%).
- There is a change in the types of clinicians who are eligible to participate. Eligible clinicians include: Doctors of Medicine • Doctors of Osteopathy (including Osteopathic Practitioners) • Doctors of Dental Surgery • Doctors of Dental Medicine • Doctors of Podiatric Medicine • Doctors of Optometry • Chiropractors AND Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, CRNA, Clinical Psychologist, Physical Therapist, Occupational Therapist, Speech-Language Pathologist, Audiologist, and Registered Dietician or Nutrition Professional.
- The MIPS low-volume exclusion includes three criteria: Bill > $90,000 in Medicare Part B Allowable charges AND > 200 individual Medicare beneficiaries AND >200 covered professional services under the PFS.
- Avoidance of penalty now requires that you earn a total of 30 points.
- The data completeness requirement for Quality is 60% of eligible instances for each measure.
- For larger practices only 1 point is earned if the data completeness threshold is not met.
- Small practices can still earn a minimum of three (3) points per quality measure when it falls below the data completeness threshold.
- The Quality category requires a full 12-month reporting period (Jan 1 – Dec 31, 2019). Six measures including at least one outcome or high priority measure need to be reported.
- Small practices can earn bonus points toward their Quality category score. Six bonus points will be added to the numerator when eligible clinicians in small practices submit at least 1 quality measure.
- Groups can earn improvement points in the Quality category based on improvement in the Quality category from the year before. Reference the Quality category fact sheet for more on how these points are determined.
Reference the fact sheets here for more information on each of the MIPS categories.
Or visit the CMS QPP website for all available information.