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Bird’s-Eye View of Final Medicare Physician Fee Schedule 2021

Quality Payment Program, QPP MIPS, MIPS data submission, MIPS Qualified Registry, Medicare Physician, MIPS 2021 data submission, MIPS eligible clinicians, MIPS 2021 Reporting, MIPS Value Pathways, QPP MIPS data reporting, MIPS score, Promoting Interoperability, Improvement Activities, MIPS data submission 2022, Accountable Care Organization, ACO Reporting Requirements, MIPS 2021 performance, QPP MIPS reporting, submit MIPS data

We are dealing with a public health emergency, and CMS has proactively come forward to facilitate clinicians in Quality Payment Program (QPP). This year, the final rule for QPP MIPS data submission required some flexibility to accommodate the pressure.

CMS recently released the final 2021 Medicare Physician Fee Schedule. P3Care, being a MIPS Qualified Registry, keeps an eye on updates. In this blog post, we have mentioned all the necessary information that MIPS eligible clinicians need to know for QPP MIPS 2021 data submission. 

QPP MIPS 2021 Reporting Highlights 

The Final Rule for the Medicare Physician Fee Schedule includes several changes as follows. These changes were finalized, keeping in check the corona situation.

Implementation of MIPS Value Pathways 

In normal conditions, MIPS Value Pathways (MVPs) were expected to come into effect from 2021. However, post-pandemic, its implementation has been delayed until 2022. Moreover, CMS is also encouraging all stakeholders in the development phase of MVPs. 

Implementation of APM-APP

Besides the QPP MIPS data reporting, CMS also plans to initiate an alternative payment reporting method. It refers to the Alternative Payment Model (APM) Performance Pathways (APP) and will be in effect from this year. This framework will align with the MVP framework.

This advancement promotes the easy transition to an alternative collection type method. For this, CMS sunsets the CMS Web Interface; however, will remain available for collection and submission type for the 2021 performance year.

MIPS Performance Categories Weights

For MIPS data submission in 2021, the weight for performance category Quality has reduced to 40 points with a decrease of 5%. Moreover, The cost performance category for QPP MIPS reporting has increased up to 5%, making 20% of the total MIPS score.

By 2022, both performance categories, Quality, and Cost must be equal at 30% of the total QPP MIPS score 2022.

The Promoting Interoperability (PI) will remain at 25%, whereas Improvement Activities (IA) at 15% for MIPS data submission 2021 score. Moreover, the performance threshold will be the same as the previous year, that is 60 points.  

Another rule for QPP MIPS data submission 2022 is about the performance threshold that will be calculated as per the median or mean of the final score of all MIPS eligible clinicians for the prior year.

Bonus for COVID-19 Complexities

For the Medicare Physician Fee Schedule, CMS also increased the bonus points for patients’ outcomes. Due to the surge of COVID-infected patients, MIPS eligible clinicians, groups, virtual groups, & APM entities can earn up to 10 points instead of 5.

ACO (Accountable Care Organization) Reporting Requirements

For the QPP MIPS 2020 performance period, ACOs reporting is considered to be affected by extreme conditions. Therefore, CMS waived off its reporting requirements to field a CAHPS for ACOs survey. In return, ACOs will receive recognition for patient outcomes without any effort.

Final Medicare Physician Fee Schedule 2022

Now, as we are about to move into MIPS 2022 performance year, CMS has released the final Medicare physician fee schedule. It suggests the standard technical proposals while setting rates for CY 2022.

In light of the CMS statement, we conceive:

The conversion factor will be $33.59 for CY 2022, which is $1.30 lesser than CY 2021. The rate factor resonates with the legal changes subject to RVUs (Relative Value Units). It also ended the 3.75% of payment increase, which was a result of the pandemic.

In the larger scheme of things, the 2022 Physician Fee Schedule promotes telehealth and high reimbursement rates to administer the vaccine. Moreover, the geographical barriers have been eliminated, especially for mental illnesses.

Conclusion

This article comprises the birds-eye view for the Medicare Physician Fee Schedule for 2021. This overview will give you an idea for designing an effective QPP MIPS reporting strategy. Quality data submission is not as hectic as it seems. However, you just need a MIPS Qualified Registry to handle the administrative load and to submit data timely to CMS.

Read our blog: 9 Reasons Why Your Practice Needs Medical Record Audit

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