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MIPS 2020: Don’t Be Caught with a 9% Medicare Payment Reduction

January 22, 2020

As MIPS enters its fourth year, the penalty for not participating rises to 9%. CMS retired 42 quality measures in 2020 including measures specific to orthopaedics, otolaryngology, neurosurgery, vascular surgery, PMR, as well as others. So whether you have been participating all along or 2020 is your first year, there are new details to follow.

KZA has been helping surgical practices navigate the maze of PQRS since 2008 and Meaningful Use since 2013. Those programs merged under MIPS in 2017. We’ve advised hundreds of surgeons over the years achieve their goals whether it be to avoid the penalty or achieve a bonus.

Below we have cultivated our top 5 tips for participating in MIPS:

1. If you have been reporting MIPS, don’t assume the measures you reported on last year are still applicable. Review your quality measures and improvement activities for changes. There were a total of 42 quality measures retired in 2020 impacting orthopaedics, otolaryngology, neurosurgery, vascular surgery, PMR, as well as others.

2. Choose quality measures that fit your specialty, even if that means choosing measures that aren’t available for reporting through your EHR. Most EHR vendors only report Electronic Clinical Quality Measures (eCQMs) that aren’t core activities for surgeons. There are indeed specific specialty measures available and they are likely activities that you are already performing. They would require an alternate submission method such as a third party intermediary. There is no requirement that quality measures must be reported through your EHR.

3. Review the hardship exemptions on an annual basis. There is a promoting interoperability hardship exemption for small practices as well as other exemptions. Apply before December 31, 2020 here.

4. Regardless of whether you’ve participated or not, be sure to sign-in to the Quality Payment Program website to review your prior year feedback report. The report shows your cost score and other valuable information.

5. Avoiding the 9% penalty is an obvious choice for most practices, while other practices want to earn the modest bonus available. Determine what is practical for your practice. What additional resources are needed to move from avoiding the penalty to earning a bonus?