Quality Payment Program 2021

MIPS 2021 Final Rule: Overview

Under the country-wide National Public Health Emergency (PHE) as a result of the COVID-19 pandemic, CMS pays attention to policies governing the Quality Payment Program (QPP) 2021. Therefore, the Merit-based Incentive Payment System 2021 keeps posing the least burden upon eligible clinicians (ECs).

MACRA MIPS is one part of the puzzle. Advanced APM is the other. To grow farther from MIPS 2020, the government continues to develop the MIPS Value Pathways (MVPs) framework, giving final touches to the fundamental principles and providing additional knowledge about them. In brief, it is something new, and stakeholders are in for a proper introduction when they collaborate with CMS.

Additionally, the Advanced APM track in 2021 is less burdensome to report. As a third-party intermediary, a Qualified Registry for five times in a row, we are ready to deliver and make it even easier for clinicians to report this year.

Most of the submission processes endure similar to that of 2020. However, the one change that we see this year is that the APM entities are no longer evaluated for their low-volume thresholds. It means a clinician in a MIPS APM has to be eligible individually or group-wise. In case you are booked by time, P3 understands 2021 MIPS requirements completely; we are willing to help you get through it seamlessly.

MIPS Reporting 2021 Eligibility Criteria

You must:

Bill more than $90,000 annually for covered medical services;
Give services to more than 200 Medicare Part B patients;
and, provide more than 200 covered services under PFS.

How to Report MIPS Data in 2021?

The process is essentially the same as it was back in 2020. The MIPS data submission methods don’t change a bit in 2021. Like before, you can report MIPS 2021 measures most effectively through the following mediums:

CMS Web Interface

Qualified Registry

Qualified Clinical Data Registry (QCDR)

Medicare Part B Claims

CAHPS for MIPS Reporting

Not to entangle in a web of confusion, it is equally sensible to mention the five collection types to follow the above submission methods. A collection type is how the data is collected from participating clinicians. The available ones are:

Electronic Clinical Quality Measures (eCQMs)

MIPS CQMs (Registry Measures)

Qualified Clinical Data Registry (QCDR) Measures

Medicare Part B Claims

The CAHPS for MIPS Survey

Healthcare Compliance in the New Year

MIPS 2021

The performance threshold increases to 60 from 45 points as decided in the CY 2020 Quality Payment Program (QPP) Final Rule
The Quality category weighs at 40% (5% decrease)
The Cost category weighs at 20% (5% increase)
The Promoting Interoperability (PI) category weighs at 25% (no change)
The Improvement Activities (IA) category weighs itself at 15% (no change)

Advanced APM 2021

Being an integral part of the QPP 2021, the Advanced APM track, takes us further into the program. Let us know what happens with it.

The performance threshold increases to 60 points
The Quality category accounts for 50% of the total MIPS score
The Cost category has a 0% portion in the total score
The Promoting Interoperability category accounts for 30% of the total score
The Improvement Activities category accounts for 20% of the total score

Note: According to official data by CMS, the law is that the Cost and Quality categories stand at equal weights for the 2022 performance year.

HOW TO SUBMIT MIPS DATA TO CMS?

Step 1
A health IT expert spends 30 minutes with you on the phone to understand the clinical workflow and requirements
Shortlisting measures and informing the practice manager of the reporting activity
Step 2
Step 3
We take care of the Cost component making sure no workload is on your practice
Self-educating ourselves through feedback based on TIN level QRUR reports
Step 4
Step 5
Regular reporting of updates in terms of compliance and CMS reporting criteria

What Does the Policy Say About Each Category?

We’ll look into each category and their policy directions to understand, implement, and report most efficiently. Like the previous year, MIPS penalty 2021 stands at 9%, and, thus requires participants to report MIPS out of necessity.

Quality

113 of MIPS Quality measures undergo substantive changes for MIPS 2021 submission
There are also some removals, a total number of 11 measures go out of the program, for instance, the All-Cause Hospital Readmission measure in not there anymore
2 new administrative claims measures come into the system such as the Hospital Wide Readmission measure
End of the CMS Web Interface as a collection and submission type, but it continues in the 2021 performance year for healthcare MIPS Quality reporting

Cost

Cost is on auto-execute for the MIPS billing cycle as CMS evaluates the category itself for eligible clinicians
Update of the existing cost measure specifications to include telehealth billing that directly relates to episode-based cost measures
The weight of the cost category is at 20% for individuals, groups, and virtual groups reporting MIPS full form in healthcare
For APM entities submitting traditional MIPS, the weight of the Cost category accounts for 0%

Improvement Activities

Revisit two of the improvement activities and get rid of one improvement activity gone obsolete
Continue with the COVID-19 clinical data reporting activity revamp as suggested in the September Interim Final Rule with Comment (IFC)
Initiate improvement activities that can be linked meaningfully with the existing MIPS 2021 quality measures in addition to Cost measures
Create a mechanism for agency-activated improvement activities

Promoting Interoperability

Retaining the Prescription Drug Monitoring Program (PDMP) measure in the PI performance category and make it worth ten bonus points
The name of the Support Electronic Referral Loops by Receiving and Incorporating Health Information changes where it says “Incorporating” and replace it by “Reconciling”
An additional Health Information Exchange (HIE) bi-directional exchange measure comes in as an alternative to two of the existing measures of HIE objective
Execute the plan to update certified electronic health record technology (CEHRT) requirements in line with the ONC 21st Century Cures Act Final Rule

ACOs and the QPP 2021 Quality Reporting Criteria

For the 2021 performance year, ACOs must report quality measures through the APM Performance Pathway (APP). They report 10 measures under the CMS Web Interface collection type or 3 CMS MIPS Quality Measures through a Qualified Registry (QR) or Qualified Clinical Data Registry (QCDR)
ACOs are also to use the CAHPS for MIPS Survey method
CMS calculates two measures using administrative claims data
Based on what an ACO chooses as its reporting method, either 6 or 10 measures become part of the total score of the ACO’s MIPS Quality category

UNMATCHED BONUSES IN MIPS 2021 FOR PHYSICAL THERAPISTS

When MIPS 2021 for physical therapy brings a new compliance score to settle with the medical world, it aligns with the benefit of clinicians at all levels. You have to ensure you are on the right track concerning MIPS 2021 compliance requirements, especially if you are a Physical Therapist (PT), Occupational Therapist (OT), and Speech-Language Pathologist (SLP).

There are occurrences of changes or updates to the program. Thus, it is only wise to revisit the 2021 requirements. P3Care, as a MIPS consultancy, stays aware of the MIPS Quality measures list for each of you. Dial-in for a free consultation or shoot us an email – info@p3care.com – to get a callback. We are eager to make this year another success for you.

Let us report together to safeguard your financial and reputational integrity.

Quality Payment Program 2021

How to Report MIPS Data in 2021?

CMS Web Interface

Qualified Registry

Qualified Clinical Data Registry (QCDR)

Medicare Part B Claims

CAHPS for MIPS Reporting

Electronic Clinical Quality Measures (eCQMs)

MIPS CQMs (Registry Measures)

Qualified Clinical Data Registry (QCDR) Measures

Medicare Part B Claims

The CAHPS for MIPS Survey

Healthcare Compliance in the New Year

MIPS 2021

Advanced APM 2021

Note: According to official data by CMS, the law is that the Cost and Quality categories stand at equal weights for the 2022 performance year.

HOW TO SUBMIT MIPS DATA TO CMS?

Step 1

Step 2

Step 3

Step 4

Step 5

Who else is all ears regarding QPP MIPS 2021 payment adjustment?

What Does the Policy Say About Each Category?

Quality

Cost

Improvement Activities

Promoting Interoperability

ACOs and the QPP 2021 Quality Reporting Criteria

UNMATCHED BONUSES IN MIPS 2021 FOR PHYSICAL THERAPISTS

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