CMS has released the final rule for MIPS 2020. Read the key takeaways here. If you’re participating in MIPS, you’ll need to know about the changes to the program in 2020. This week, CMS released the Quality Payment Program proposed rule for the next performance year. While their goal is to maintain many of the requirements from the 2019 performance year, there are some updates to the MIPS track. Here are the highlights of the proposed changes.
Quality and Cost performance category weights
In 2020, the Quality performance category weight will be reduced from 45 percent to 40 percent. The Cost category weight will increase from 15 percent to 20 percent.
The maximum negative payment adjustment will increase from -7% to -9% in 2020. Positive payment adjustments (not including exceptional performance) will increase from 7% to up to 9%.
The performance threshold–the minimum number of points to avoid a negative payment adjustment–will increase from 30 points in 2019 to 45 points in 2020. The exceptional performance threshold, which determines additional positive payment adjustments, will increase to 80 points in 2020. A full breakdown of proposed MIPS changes can be found in the table below. CMS is accepting feedback on the proposed rule at regulations.gov through September 27, 2019 with the file code CMS-1715-P. CMS has also proposed larger changes to the program starting in 2021. Click here to read our summary of their new proposed framework. For more information on the current MIPS performance year and how SurveyVitals can help you fulfill your requirements, visit our MIPS page or chat with us using the blue chat icon below.
|Policy Area||Current Year 3 (Final Rule CY 2019)||Year 4 (Proposed Rule CY 2020)|
|Performance Category Weights||
|Quality Performance Category||Data Completeness Requirements
||Data Completeness Requirements
|Improvement Activities Performance Category||Definition of Rural Area Rural area means a ZIP code designated as rural, using the most recent Health Resources and Services Administration (HRSA) Area Health Resource File data set available. Patient-Centered Medical Home Criteria To be eligible for Patient-Centered Medical Home designation, the practice must meet one of the following criteria:
||Definition of Rural Area Rural area is proposed to mean a ZIP code designated as rural by the Federal Office of Rural Health Policy (FORHP) using the most recent FORHP Eligible ZIP Code file available. Patient-Centered Medical Home Criteria To be eligible for Patient-Centered Medical Home designation, the practice would need to meet one of the following criteria:
|Promoting Interoperability Performance Category – Hospital-Based MIPS Eligible Clinicians in Groups||A group is identified as hospital-based and eligible for reweighting when 100% of the MIPS eligible clinicians in the group meet the definition of a hospital-based MIPS eligible clinician.||A group would be identified as hospital-based and eligible for reweighting if more than 75% of the NPIs in the group meet the definition of a hospital-based individual MIPS eligible clinician. For non-patient facing groups (more than 75% of the MIPS-eligible clinicians in the group are classified as non-patient facing) we would automatically reweight the Promoting Interoperability performance category. No change to definition of an individual hospital-based MIPS eligible clinician.|
|Promoting Interoperability Performance Category||Objectives and Measures
||Objectives and Measures
|Cost Performance Category||Measures
|Final Score Calculation: Performance Category Reweighting due to Data Integrity Issues||
|Performance Threshold / Additional Performance Threshold / Payment Adjustment||
|Targeted Review||MIPS eligible clinicians and groups may submit a targeted review request by September 30 following the release of the MIPS payment adjustment factor(s) with performance feedback.||All requests for targeted review would be required to be submitted within 60 days of the release of the MIPS payment adjustment factor(s) with performance feedback.|