CMS Reweights Scoring for Cost Category for Groups in 2021 Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) announced on Monday, April 25th, that ALL eligible MIPS providers will automatically receive re-weighting of the Cost category from 20% to 0% in their 2021 final calculation – even for those who reported as Groups or Virtual Groups.  This means that all QPP and MIPS provider participants – regardless of their status in 2021 MIPS as an individual (previously granted), group, virtual group, or APM entity.

CMS notes that “Cost will be reweighted to 0% for all groups and virtual groups reporting traditional MIPS, even if they didn’t request reweighting of this performance category through an extreme and uncontrollable circumstances (EUC) exception application.”  As a reminder, the weights of the four categories before and after this announcement are shown below; as in the 2020 re-weighting for Cost, this change to a single area of MIPS is split between the Quality (15% increase) and Program Interoperability (5% increase) areas.

Quality Cost Improvement Activities Program Interoperability
2021 Before 40% 20% 15% 25%
2021 Now 55% 0% 15% 30%

 

If a practice has other re-weighting from hardship exceptions or special statuses in MIPS (Small practice, for example), CMS notes that those remain in effect and this change is additive.

CMS noted they could not “reliably calculate” these Cost scores because:

  • Most measures have higher observed and risk-adjusted costs at the episode-level. This indicates that risk adjustment at the episode-level doesn’t entirely account for differences in resource use, particularly for broader measures or measures that are clinically proximate to respiratory disease and COVID-19.
  • There’s less of an effect at the provider-level for most measures where testing shows that scores don’t appear to be adversely impacted by higher case-loads of episodes with a recent or concurrent COVID-19 diagnosis. However, there are a small number of measures where scores may be adversely affected by the volume of episodes with a COVID-19 diagnosis.

CMS gave some rationale this time (unlike in their 2020 year guidance) in a slide presentation in the QPP Resource Library (link here).  If you want to see the new information for yourself, apply these filters and open the PDF file titled “2021 Traditional MIPS Scoring Guide” and go to slide 82 of the presentation:

  • Performance Year: 2021
  • QPP Reporting Track: MIPS
  • Performance Category: ALL
  • Resource Type: ALL

We are available and happy to assist you with issues related to eye care coding and reimbursement.  We are happy to assist with Year 6 (2022) MIPS reporting and the significant changes for 2021 Evaluation and Management eye exam coding.

We are available and happy to assist you with issues such as this and other topics related to eye care.  We’re proud to assist with questions related to 2021 changes on Evaluation and Management eye exam coding, the increased activity from payers (e.g., Private payers, and the CMS TPE, RAC, and SMRC reviews) so contact us if you need our help with these responses.  Stay safe in this challenging time.

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