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Practice Fusion · Dec 18, 2019

Five important facts about 2020 MIPS for Small Practice Providers

On November 1, 2019, the 2020 Physician Fee Schedule Final Rule was released laying out the 2020 performance year requirements for the Merit based Incentive Payment System (MIPS). While many program requirements remain, additional requirements have been included to better reflect the work and effort of specialties and to better identify physician practice type. Below you will find five things the Practice Fusion regulatory team believes are most important for small practice providers to be aware of as the 2020 performance year approaches.

  1. The MIPS Performance Threshold has increased: To avoid a negative payment adjustment as a result of the 2020 performance year, MIPS eligible clinicians will be required to earn a minimum of 45 points. Those who earn less than 45 points may be subject to a -9% payment adjustment when payment adjustments are released in 2022. MIPS eligible clinicians aiming for the exceptional performance adjustment will need to earn a minimum of 85 points during the 2020 MIPS performance year.
  2. The MIPS Performance Categories are weighted the same as 2019: Rather than shift the weighting of the performance categories, as was suggested in the Physician Fee Schedule proposed rule, CMS has chosen to retain the performance category weightings established during the 2019 performance year. The weighting of the MIPS performance categories will be as follows:
    a. Quality: 45%
    b. Cost: 15%
    c. Promoting Interoperability: 25%
    d. Improvement Activities: 15%
  3. The MIPS Data Completeness threshold has increased: During the 2020 performance year MIPS eligible clinicians will continue to be required to submit at least 6 CQMs to earn full performance category points, one of which must be either an outcome or another applicable high priority measure. However, the data completeness threshold required for these six CQMs has been increased to 70%.
  4. Rural Areas and Patient Centered Medical Home (PCMH) Criteria: Beginning in the 2020 performance year, the definition of both rural areas and PCMH have been updated to more accurately reflect their intended use. Rural area will now be classified as a ZIP code designated by the Federal Office of Rural Health Policy (FORHP) using the most recent data available. In a similar fashion CMS has updated PCMH criteria by removing the previous reference to the specific accrediting organization for comparable specialty practices.
  5. MIPS Value Pathways will start in 2021: CMS has decided to move forward with MIPS Value Pathways, a conceptual framework that will allow MIPS eligible clinicians to participate through an aligned set of measure options that are more relevant to their specific scope of practice. MIPS Value Pathways will be officially introduced as a participation option in the 2021 performance year. Practice Fusion will provide more information about MIPS Value Pathways throughout 2020 as CMS releases educational information related to the program.

Approaching January 1, 2020 As the end of the year approaches and a new year begins, so will the implementation of the MIPS 2020 performance year changes. Awareness of these changes is a necessary factor for a physician’s success when enrolling and participating in MIPS. Practice Fusion providers can be assured the regulatory team is taking the necessary steps to ensure all providers are educated and aware of the rules and provisions that will affect them in the 2020 MIPS performance year.

For more information on the MIPS program in performance year 2020, please refer to the CMS site here.