One thing that we learn from the year 2020 for sure is uncertainty. COVID-19 pandemic has left us in a state of doubt where we can’t be too sure of our present and, clearly, not of the future.
QPP MIPS reporting program of 2019 also had to face delays due to this catastrophe with overburdened staff, doctors, and suppliers associated with them any capacity. The closing date for MIPS 2019 went one-month further to facilitate clinicians busy dealing with the surge in COVID-19 patients. It was indeed a rollercoaster ride for them from the very first day.
MIPS 2020 reporting, however, is still very much happening and clinicians are required to submit data as individuals, groups, and virtual groups to receive positive payment adjustments. One of the ways to do that is to score above 45.
Contrary to the previous years, MIPS 2020 program requires clinicians to submit data for all the reportable performance categories to avoid negative payment adjustments. Regardless of the method you use, it is not possible to score above 45 by submitting only the Quality measures.
Check Your Participation Status
The first thing to do while reporting MIPS 2020 is to check whether you are eligible for the program or not. Special statuses qualification also awaits certain surgeons. Once you are there, include your NPI to display the required participation status.
Surgeons with special statuses may get bonus points and also have their categories reweighted.
Select Quality Measures Carefully
Instead of being casual about the Quality measures, my next tip is to be careful about them. It is crucial to choose only those Quality measures with benchmarks that do not limit your points that you may score on that measure.
For example, many surgery-driven measures are topped-out, and you can score as much as 7 points through them, which may tempt you to look for other measures, outcome measures, or high-priority measures resulting in bonus points.
Participate in COVID-19 Clinical Trials Improvement Activity
While the COVID-19 pandemic has left us with many questions, it poses a challenge to humanity to figure a way out of it. Thankfully, MIPS 2020 reporting, now, has a new high-weighted COVID-19 clinical trial activity to add to the total scores for MIPS eligible clinicians. While it is an opportunity to score high, it can help you receive recognition for breakthroughs you are making against COVID-19.
The two ways you can utilize this IA and receive credit for it:
- Participate in a COVID clinical trial and have that data become part of a data portal for an ongoing study; or
- Caring for COVID patients, you may submit clinical data to the clinical data registry for future references.
National Institutes of Health (NIH) hold Covid-19 clinical trials, and that is where participation starts. The goal of this Improvement Activity (IA) is to innovate and improve the collection of COVID-19 information that the clinicians have and develop best practices in patient care as COVID-19 drags on.
Let’s hope for the best outcomes shortly. MIPS Qualified Registries submit measures for all the reportable measures. Therefore, signing up with one of those registries is a good start.
Scoring Cases for Clinicians with Special Statuses
The cost category is excluded from the examples below because the category uses complex claims data to calculate scores.
Scoring example for clinicians who are eligible for PI exemptions
- 25% of the weight of the PI category transfers into Quality, reweighting it to 70% of the total score.
- (26 measure points in Quality are equal to 30 MIPS points approximately) + (IA’s complete submission is equal to 15 points) = 45 points
Scoring example for physician groups of 15 or fewer
- If they report at least one Quality measure, they receive six bonus points for the Quality category.
- (20 measure points + 6 bonus points in Quality = around 30 MIPS points) + (IA’s complete submission is equal to 15 points) = 45 MIPS points
Recommendation of the American College of Surgeons
45 is the safest score for MIPS 2020 submissions regardless of the submission method you use. American College of Surgeons also recommends the above techniques to score high and handsome and stay at ease in the compliance program.
There are no changes in eligibility status and opt-in determinations. The criteria are simple, and with the COVID situation going on, MIPS eligible clinicians can also report their preparation and planning in regards to receive reimbursements.
The threshold is certainly high this time, but clinicians who are prepared and have good specialty-specific measures to report can show outstanding performance.
So, there’s nothing to fear. It’s just a program for clinicians to get incentives as a reward to improve their quality care delivery.