The Centers for Medicare & Medicaid Services (CMS) released the 2020 Physician Fee Schedule (PFS) final rule which contained the revised MIPS requirements. Next year CMS is upping the minimum score requirements and plan to post your 2018 MIPS performance to Physician Compare.
In the 2020 QPP Final Rule Fact Sheet, CMS highlights the fact that they attempted to ease people into the MIPS program by increasing the minimum score gradually from 3 points in 2017 to 15 points in 2018, 30 points in 2019 and now 45 points in 2020.
The Exceptional Performance Threshold score increased from 75 points in 2019 to 85 points in 2020, which is a 10 point difference. Penalties and incentives have changed for the 2020 reporting period. The penalty for not reporting at least 45 points is a -9 percent to 0 percent towards a provider’s Medicare fee schedule. If a provider exceeds the minimum score of 45 points the provider could possibly receive up to 9 percent increase to their Medicare fee schedule.
The Quality Category data completeness threshold is 70 percent of all patients across all payers on claims, Electronic clinical quality measures (eCQMs), Registry, and Qualified Clinical Data Registry (QCDR) measures instead of 60 percent in 2019. In 2019, CMS evaluated your performance for these measures for the Cost category; Total per capita cost (TPCC), Medicare Spending Per Beneficiary (MSPB), and 8 episode-based measures. In 2020 CMS will maintain the existing 8 episode-based measures and add 10 new episode-based measures. CMS has also revised the TPCC and MSPB measure specifications.
Last year one provider may have carried the group with Improvement Activities, but for 2020 at least 50 percent must attest to completing the same improvement activity for 90 consecutive days. The activities may be completed anytime within the calendar year. Some additional changes to the IA category are the addition of 2 Improvement Activities, the modification of 7 existing improvement activities (IA), and the removal of 15 IA.
Changes reflecting for the Promoting Interoperability (PI) Category, CMS is including the Query of Prescription Drug Monitoring Program (PDMP) measure as an optional measure. They are removing Verify Opioid Treatment Agreement. In 2019, to have the category reweighted meaning your PI category weight would go to 0 and your Quality category weight would increase to 70 your group must have 100 percent of the clinicians meeting the CMS definition of a hospital-based clinician. In 2020, the requirement goes down. If reporting as a group only 75 percent of your group must meet the hospital-based clinician definition to qualify for reweighting of PI.