Quality Payment Program (QPP) participants can now obtain information about whether their practice will receive a positive, negative, or neutral Medicare fee schedule adjustment in 2021 based on the 2019 data they submitted. The Centers for Medicare and Medicaid Services (CMS) announced that clinicians who participated in the Merit-based Incentive Payment System (MIPS) in 2019 can access their performance feedback by logging in to the Quality Payment Program website.
The payment adjustments that will take effect in 2021 range from a reduction of 7% to an increase of 1.79% over the basic Medicare fee schedule. For the 2020 payment year, the range was from -5% to +1.68%.
The MIPS program is designed to be budget-neutral, so for every positive adjustment there has to be a corresponding negative adjustment. The maximum positive adjustment is awarded only to those practices achieving a final score of at least 75 points, which entitles them to participate in the Exceptional Performance bonus. This bonus comes from a separate $500 million fund to be applied over the first six years of the program to allow additional adjustments for Exceptional Performance. These adjustments are not budget neutral, allowing exceptional performers to achieve higher positive adjustments. The Exceptional Performance threshold is increasing each year, so it will become harder to achieve as time goes on.
In practical terms, a practice that usually receives annual Medicare reimbursement of $1 million could see a 2021 payment reduction of $70,000 (7%) if they did not participate in MIPS. A practice that achieved the highest possible score will see a 1.79% positive adjustment of $17,900. That’s a reward of $87,900 for taking the right steps to maximize their results.
When you go to check your performance data, be aware that CMS will be updating its QPP website later this year for network security enhancement, which means that older browsers and operating systems will not be able to access the site. Full information is available by downloading a fact sheet from CMS and the ability to test your system now is available on the QPP website.
If after reviewing your data you feel that there was an error in the calculation of your practice’s 2021 payment adjustment factor, a Targeted Review is available from CMS. A request may be submitted by October 5, 2020. The Targeted Review User Guide is available for more information.
Just as the threshold for exceptional performance will be raised each year, so will the minimum score to avoid a negative adjustment. Thus, it will become more difficult to avoid the penalty and the rewards for higher scores will become greater. Subscribers to this blog will be best positioned with information to earn the highest possible reimbursement as the QPP evolves.
Erin Stephens, CPC, CIRCC is the Sr. Client Manager, Education at Healthcare Administrative Partners.