MIPS 2021 Updates

Since 2020 has ended and the new year has begun, it is important to stay abreast of the new requirements for MIPS in 2021. Below is a list of key highlights that will play a large role in how you report for MIPS this year.

MIPS Category Changes

Performance Category 2020 Weight 2021 Weight
Quality 45% 40%
Cost 15% 20%
Promoting Interoperability 25% 25% (no change)
Improvement Activities 15% 15% (no change)

Quality Category

For 2021, you must still report 6 measures for at least 70% of your eligible Medicare Part B patients for the year. The following changes have been made to this category:

  • 12 Measures have been removed from the MIPS reporting
Quality Measures Removed for 2021
#012 Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation (*this measure will still be available for reporting as an eCQM)
#069 Hematology: Multiple Myeloma: Treatment with Bisphosphonates
#146 Radiology: Inappropriate Use of “Probably Benign” Assessment Category in Screening Mammograms
#333 Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse)
#348 Implantable Cardioverter-Defibrillator (ICD) Complications Rate
#390 Hepatitis C: Discussion and Shared Decision-Making Surrounding Treatment Options
#408 Opioid Therapy Follow-up Evaluation
#412 Documentation of Signed Opioid Treatment Agreement
#414 Evaluation or Interview for Risk of Opioid Misuse
#435 Quality of Life Assessment for Patients with Primary Headache Disorders
#437 Rate of Surgical Conversion from Lower Extremity Endovascular Revascularization Procedure
#458 All-Cause Hospital Readmission (Administrative Claims measure)
  • CMS has added 2 administrative claims measures
    • Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Eligible Clinician Groups
    • Risk-standardized complication rate (RSCR) following elective primary total him arthroplasty (THA) and/or total knee arthroplasty (TKA) for MIPS Eligible Clinicians

Promoting Interoperability (PI) Category

CMS has made the following changes to this category:

  • Retained the Query of PDMP measure as an optional measure and makes it worth 10 bonus points.
  • Changed the name of the Support Electronic Referral Loops by Receiving and Incorporating Health Information measure by replacing “incorporating” with “reconciling”.
  • Added an optional Health Information Exchange (HIE) bidirectional exchange measure.
  • Preserved the automatic reweighting policies for the following clinician types:
    • Nurse Practitioners (NPs)
    • Physician Assistants (PAs)
    • Certified Registered Nurse Anesthesiologists (CRNAs)
    • Clinical Nurse Specialists (CNSs)
    • Physical Therapists
    • Occupational Therapists
    • Qualified Speech-language Pathologist
    • Qualified Audiologists
    • Clinical Psychologists Registered Dieticians or Nutrition Professionals

Cost Category

Aside from the weight change to 20% for the overall MIPS score, there have not been any major changes to the Cost Category. CMS has maintained the existing Cost measures from 2020, and they have added telehealth services directly applicable to existing episode-based cost measures and the TPCC measure.

Improvement Activities (IA) Category

There have been no major changes to this category for MIPS 2021. CMS has continued the COVID-19 clinical data reporting Improvement Activity with a modification to the activity description (see below for requirements).

  • MIPS eligible clinician or group must participate in a COVID-19 clinical trial utilizing a drug or biological product to treat a patient with a COVID-19 infection and report their findings through a clinical data repository or clinical data registry for the duration of their study; or
  • MIPS eligible clinician or group must participate in the care of patients diagnosed with COVID-19 and simultaneously submit relevant clinical data to a clinical data registry for ongoing or future COVID-19 research

CMS has removed “CMS Partner in Patients Hospital Engagement Network” and modified 2 activities for 2021 below:

  • Engagement of patient through implementation of improvements in patient portal
  • Comprehensive Eye Exams

Minimum Threshold to Avoid Penalties

CMS has increased the minimum threshold to avoid penalties from 45 in 2020 to 60 in 2021. In other words, you must achieve at least 60 points in your MIPS score to avoid any penalty. The performance threshold for the exceptional performance status remains the same at 85 points.

Payment Adjustments

There is no change to the MIPS payment adjustment from 2020 to 2021. This value remains at +/-9% depending on your MIPS score for 2021. The penalties or incentives from MIPS reporting in 2021 will be applicable to your Medicare reimbursements in 2023.

Due to the changes above, it is very important for you to develop a strong reporting plan for 2021. Carefully review the list of Quality measures that have been removed to find out if you have previously reported on these measures. If so, you will need to find Quality measures that work for you and your practice to replace the ones that have been removed. Fully reporting on all MIPS measures will be absolutely necessary to reach the minimum threshold of 60 points and avoid the 9% penalty for 2021. TriumpHealth’s well-trained MIPS consultants can create the best plan to help you reach your reporting goals and maximize revenue.

by Madison Ross – Healthcare Sales Representative | TriumpHealth