All

MIPS 2021 Updates

telemed21
12 Jan

MIPS 2021 Updates

MIPS 2021 Updates

Since 2020 has ended and the new year has begun, staying abreast of the latest requirements for MIPS in 2021 is essential. Below is a list of key highlights that will significantly affect how you report for MIPS this year.

MIPS Category Changes

Performance Category 2020 Weight 2021 Weight
Quality 45% 40%
Cost 15% 20%
Promoting Interoperability 25% 25% (no change)
Improvement Activities 15% 15% (no change)

Quality Category

For 2021, you must still report six measures for at least 70% of your eligible Medicare Part B patients for the year. The following changes have been made to this category:

  • 12 Measures have been removed from the MIPS reporting
Quality Measures Removed for 2021
#012 Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation (*this measure will still be available for reporting as an eCQM)
#069 Hematology: Multiple Myeloma: Treatment with Bisphosphonates
#146 Radiology: Inappropriate Use of “Probably Benign” Assessment Category in Screening Mammograms
#333 Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse)
#348 Implantable Cardioverter-Defibrillator (ICD) Complications Rate
#390 Hepatitis C: Discussion and Shared Decision-Making Surrounding Treatment Options
#408 Opioid Therapy Follow-up Evaluation
#412 Documentation of Signed Opioid Treatment Agreement
#414 Evaluation of Interview for Risk of Opioid Misuse
#435 Quality of Life Assessment for Patients with Primary Headache Disorders
#437 Rate of Surgical Conversion from Lower Extremity Endovascular Revascularization Procedure
#458 All-cause hospital Readmission (Administrative Claims measure)
  • CMS has added two administrative claims measures
    • Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Eligible Clinician Groups
    • Risk-standardized complication rate (RSCR) following elective primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) for MIPS Eligible Clinicians

Promoting Interoperability (PI) Category

CMS has made the following changes to this category:

  • Retained the Query of PDMP measure as optional, making it worth ten bonus points.
  • They changed the name of the Support Electronic Referral Loops by Receiving and Incorporating Health Information measure by replacing “incorporating” with “reconciling.”
  • An optional Health Information Exchange (HIE) bidirectional exchange measure was added.
  • Preserved the automatic reweighting policies for the following clinician types:
    • Nurse Practitioners (NPs)
    • Physician Assistants (PAs)
    • Certified Registered Nurse Anesthesiologists (CRNAs)
    • Clinical Nurse Specialists (CNSs)
    • Physical Therapists
    • Occupational Therapists
    • Qualified Speech-language Pathologist
    • Qualified Audiologists
    • Clinical Psychologists, Registered Dieticians, or Nutrition Professionals

Cost Category

Aside from the weight change to 20% for the overall MIPS score, there have not been any significant changes to the Cost Category. CMS has maintained the existing cost measures since 2020 and added telehealth services directly applicable to existing episode-based cost measures and the TPCC measure.

Improvement Activities (IA) Category

There have been no significant changes to this category for MIPS 2021. CMS has continued the COVID-19 clinical data reporting Improvement Activity with a modification to the activity description (see below for requirements).

  • MIPS-eligible clinicians or groups must participate in a COVID-19 clinical trial utilizing a drug or biological product to treat a patient with a COVID-19 infection and report their findings through a clinical data repository or clinical data registry for the duration of their study or
  • MIPS-eligible clinicians or groups must participate in the care of patients diagnosed with COVID-19 and simultaneously submit relevant clinical data to a clinical data registry for ongoing or future COVID-19 research

CMS has removed “CMS Partner in Patients Hospital Engagement Network” and modified two activities for 2021 below:

  • Engagement of patients through the implementation of improvements in the patient portal
  • Comprehensive Eye Exams

Minimum Threshold to Avoid Penalties

CMS has increased the minimum threshold to avoid penalties from 45 in 2020 to 60 in 2021. In other words, you must achieve at least 60 points in your MIPS score to avoid a penalty. The performance threshold for the exceptional performance status remains the same at 85 points.

Payment Adjustments

There is no change to the MIPS payment adjustment from 2020 to 2021. This value remains at +/-9%, depending on your MIPS score for 2021. The penalties or incentives from MIPS reporting in 2021 will apply to your Medicare reimbursements in 2023.

Due to the changes above, you need to develop a strong reporting plan for 2021. Review removed Quality measures to see if you reported on them before. If so, you may need to find new Quality measures that work for your practice to replace the removed ones. Fully reporting on all MIPS measures will be necessary to reach the minimum threshold of 60 points and avoid the 9% penalty for 2021. TriumpHealth’s well-trained MIPS consultants can create the best plan to help you achieve your reporting goals and maximize revenue.

by Madison Ross – Healthcare Sales Representative | TriumpHealth