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MIPS 2021 Final Rule: Overview
Under the country-wide National Public Health Emergency (PHE) as a result of the COVID-19 pandemic, CMS paid attention to policies governing the Quality Payment Program (QPP) 2021. Hence, the Merit-based Incentive Payment System (MIPS) 2021 being part of this focus, keeps on posing the least burden upon eligible clinicians (ECs).
MACRA MIPS is one part of the puzzle. Advanced APM is the other. To grow further 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. Briefly, it is something new, and stakeholders are in for a proper introduction when they collaborate with CMS.
Also, the Advanced APM track is going to be less burdensome to report. As a third-party intermediary, a Qualified Registry, and a MIPS consulting firm, we are ready to go the distance and make it even easier for clinicians to report this year.
Before Everything Else Let Us Know the MIPS Reporting 2021 Eligibility Criteria
Most of the process endures similar to 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 seamlessly.
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:
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:
HOW TO SUBMIT MIPS DATA TO CMS?
Shortlisting measures and informing the practice manager of the reporting activity
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
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.
- 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 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%
- 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
- 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