In 2015, MACRA, the Medicare Access and CHIP Reauthorization Act created the Quality Payment Program (QPP) and transformed the Medicare physician payment system from one based on volume to one based on value. QPP has two tracks: Merit-Based Incentive Program (MIPS) and Advanced Alternative Payment Models (APMs).
How you score against a 100-point performance scale will determine your Medicare Part B service payments. The categories assessed are Cost, Quality, Promoting Interoperability (formerly known as Advancing Care Information), Improvement Activities, and Complex Patient Bonus.
Late in 2018, the U.S. Centers for Medicare and Medicaid (CMS) released the final rules governing the Medicare QPP, with updates for 2020 released in late 2019.
Easily Digestible Highlights
1. New category weights
For 2019, there were changes to two of the four performance categories that make up the score determining your payment adjustment.
- Cost increased from 10% to 15%
- Quality decreased from 50% to 45%
- Promoting Interoperability stays at 25%
- Improvement Activities stays at 15%
2. Higher payment adjustments
If eligible, your MIPS performance will decide whether you receive an adjustment of ±9% on your Medicare reimbursements going forward, up from ±7% in 2019.
3. New performance thresholds
CMS is increasing the MIPS performance threshold to 45 points in 2020 (up from 30 points in 2019) and 60 points in 2021.
4. Increased threshold for top performers
To be eligible for a share of the $500 million exceptional performance bonus (separate from the $390 million adjustment pool), you will need to score a minimum of 75 MIPS points, up from 70.
5. More eligible clinicians
These clinicians are now eligible to participate:
- Physical therapists
- Occupational therapists
- Qualified speech-language pathologists
- Qualified audiologists
- Clinical psychologists
- Registered dietitians or nutritional professionals
6. Increased Quality measures
Beginning in 2020, data completeness requirements will increase from 60% to 70%. For the entire year, Quality measures will need to be reported on at least 70% of eligible cases for both Medicare and non-medicare patients. Measures that are submitted, but do not meet the data completeness threshold (even if they have a measure benchmark and/or meet the 20 case minimum), would receive 0 points (instead of 1 point in 2019). Clinicians in small practices (15 or less in the TIN) would continue to receive 3 points for measures that don’t meet the data completeness requirements.
Reporting is Easier With the Right Partner
If you think MACRA is a complex set of rules, you’re right. But there is a simple solution. Confirm that your Electronic Health Record system (EHR) is MACRA-certified and allows you to capture measures within your existing workflow. It will help you meet the CMS reporting requirements without adding extra steps, resulting in higher payments, improved compliance, and more accurate patient records. If you’re an RXNT customer or considering our EHR—good news!—our solution is MACRA- and MIPS-certified!