CMS Publishes 2020 Payment Adjustments related to 2018 MIPS/QPP Performance

CMS recently made available the MIPS payment adjustment information for 2020.  Practices can check their results by logging in to the QPP.CMS.GOV webpage.  It appears from information received by our clients that the maximum bonus in 2020 for a perfect score is 1.68%.  That means that practices who scored a perfect 100% on 2018 MIPS will receive that adjustment on all individual Part B services delivered in 2020.  This 1.68% number reflects the sum of the basic MIPS positive payment adjustment (bonus) as well as the non-budget-neutral “exceptional performer” bonus.

Do not forget that the all QPP/MIPS payment adjustments are reflected in your EOBs in an unusual way.  Be sure to “harvest the positive adjustments” and place them in a non-patient account; leaving them in the patient account as a credit will mean giving them away over the course of the year as future visits occur.  Most practice management systems can do this correctly but do check.  We can help with this if there are questions.

The CMS Administrator, Seema Verma, noted in a post she authored for the CMS Blog on January 6, 2020, the following facts about 2018 MIPS overall performance:

  • 98 percent of clinicians avoided a negative payment adjustment, compared to 95 percent from last year. From a scoring perspective, the overall national mean (or average) and median scores increased from 2017.
  • Clinicians who specifically participated in MIPS through an APM had a mean score of 98.77 and a median score of 100.
  • 97 percent of eligible clinicians in rural practices will receive a positive payment adjustment, compared to 93 percent in 2017.
  • For small practices, 84 percent of eligible clinicians received a positive payment adjustment, an increase from 74 percent in 2017.

While the CMS Blog post is very upbeat, it also reflects the rationale for why these 2020 positive payment adjustments are lower for perfect scores than the 2019 payments (too many people were NOT penalized at all).  While we do not have much data at this time for other scoring levels, it is likely the trend to lower overall for equivalent scores is true.

We are happy to assist you with QPP and MIPS issues and other topics, which include: proper code selection, claims issues, chart reviews and payer questions. Our new Practice Improvement Partnership (PIP) can assist with operations, practice optimization, and efficiency.  We provide training on all these subjects. You can download our “App”, Corcoran 24/7 via one of the links below. (800) 399-6565

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