MIPS Payment Adjustment
Payment Adjustments are budget neutral and made on a sliding scale. To maintain budget neutrality, the physicians with the higher final scores may be eligible for the positive payment adjustment up to three times the baseline positive payment adjustment for a given year.
Payment adjustments based on the final score, is based on the performance of two years (e.g. performance in 2023 determines the payment adjustment in 2025)
Clinicians who score above the performance threshold will receive positive payment adjustments on a sliding scale and the clinicians who score below the performance threshold will receive the negative payment adjustment on a sliding scale. The performance threshold will get published by the CMS before the start of every performance year.
An exceptional performance threshold. If at or above the year’s score, MIPS-eligible clinicians and groups are eligible for the additional bonus beyond the positive MIPS payment adjustment.
Exceptional performers that meet the additional performance threshold will receive an additional sliding scale positive payment adjustment of up to 10%. The exceptional performance threshold for the MIPS reporting performance year 2020 has been set at 85. Exceptional performance adjustment occurs outside of budget neutrality.
MPS Reporting payment adjustments are required to be budget neutral. That’s the reason why positive payment adjustment factors increase or decrease or (scaled) by an amount called a scaling factor.
2022 MIPS Reporting Payment Year Payment Adjustment
In August 2021 each MIPS-eligible clinician has received a 2020 MIPS Final Score and 2022 MIPS payment adjustment information as it is a part of their performance feedback. MIPS 2022 payment adjustment determined by the MIPS 2020 Final Score. It has affected the payments made for the services in the performance year 2022 also referred to as the MIPS 2022 payment year.
Who Has Received the MIPS Payment Adjustment in 2022?
MIPS-eligible clinicians were identified by the combination of NPI/TIN for the 2020 performance year and they have received the payment adjustment in 2022. Especially you have received the MIPS Reporting payment adjustment in the 2022 MIPS Performance Year if you were:
- A clinician that was enrolled in MIPS Quality Measures
- Enrolled as a Medicare provider before 1st January,2020
- If you weren’t identifying as Qualifying Alternative Payment Model (APM)
- Also, if you were a Partial APM participant (Partial QP) that were elected to participate in MIPS as a MIPS eligible clinician
Below are of the following criteria to get enrolled in MIPS 2022 Reporting
- Exceeded the low-volume threshold individually
- You were in the practice that exceeded the low-volume threshold at the group level and had submitted the group data
- Were Opt-in eligible and elected to opt-in to MIPS as an individual or a group
- We’re part of an approved virtual group
- Were in MIPS Reporting APM and APM entity group exceeds the low-volume threshold or opted into MIPS
- A single clinician that has been identified by the NPI that bill Medicare under multiple TINs during the year 2020 has received a separate MIPS 2020 Final Score for each of his/her unique TIN/NPI combinations.
- These clinicians may have received the different MIPS payment adjustments for the professional services that are covered, furnished, and billed under each of their TIN/NPI combinations in the MIPS 2022 performance year.
MIPS 2021 Performance Final Score
Your MIPS final score is included in your final performance feedback and the total payment adjustment will apply after 1st January 2023.
MIPS Payment Adjustment Overview
MIPS-eligible clinicians with a final score equal to the performance threshold will not receive an adjustment. Eligible clinicians with a final score above the performance threshold will receive an upward adjustment while those with a final score below the performance threshold will receive a downward adjustment.
Payment Adjustment Final Score Calculation
For each MIPS-eligible clinician, the adjustment factor will be determined with a linear sliding scale from zero to 100, with 100 being the highest possible upward adjustment and zero being the maximum downward adjustment. Two changes need to be made before the linear sliding scale is used. The first step is to apply the greatest downward adjustment. The maximum negative MIPS adjustment factor for the MIPS payment year will be given to participants with final scores between zero and one-fourth of the performance threshold. The scaling factor, which ranges from 0 to 3, is then multiplied by all positive MIPS adjustment factors. Only physicians who qualified and had a final score exactly at the performance criteria would not be adjusted.
Those qualified physicians who receive an upward adjustment and the highest final score in payment years 2019 to 2024 are eligible for an exceptional performance payment. The “additional performance threshold” set by CMS will specify which qualified clinicians are eligible for the exceptional performance payment. The 25th percentile of the results above the performance criterion is where the additional performance barrier is set.
The eligible clinicians with the highest final score will receive an exceptional performance adjustment not to exceed 10%, and those with the additional performance threshold (the 25th percentile above the final score threshold score, as shown by the rightmost vertical line in Figure 3) will receive a 0.5% adjustment. To ensure that the total incentive payments for exceptional performance do not exceed $500 million each year, a scaling factor will be added to the exceptional performance adjustment. To do this, this scaling factor must range from 0 to 1, which can only result in a reduction in extraordinary performance modifications.
A final score’s conversion to a MIPS adjustment
Each TIN/final NPI score will be converted to a MIPS adjustment once it has been calculated. Starting in 2019, all payments made during a particular payment year will be subject to the MIPS adjustment factor. Always two years before the payout year is the performance year. The potential MIPS adjustment goes from -/+4% to -/+9% in either direction (see the table in Figure 4). A scaling factor (shown as X in Figure 4) between 0 and 3 will be added to upward adjustments (calculated each year to ensure budget neutrality). This means that the potential upward adjustment for the payment year 2019 varies from zero (if there are no downward adjustments) to 12% (if there are enough downward adjustments).
Payment Adjustment Take Effects 2023 MIPS Reporting
In 2023 payment adjustments Medicare has begun to apply for Part B services based on the 2021 Merit-Based Incentive Payment System (MIPS) score. All of the eligible clinicians received a 2021 MIPS reporting final score in August 2022. The payment adjustment applied to each clinician’s Medicare claims is based on the final score connected to their Taxpayer Identification Number (TIN)/National Provider Identifier (NPI).