We all know that MIPS 2021 reporting has been struck by the corona pandemic, which has affected many areas more or less. Fortunately, CMS (Centers for Medicare and Medicaid Services) has granted some relaxation that can be helpful and convenient for MIPS Qualified Registries and healthcare professionals.
A Little History about Reporting
This inventive payment program promoted quality and value-based healthcare that happens to cover areas of:
- Promoting Interoperability
- Improvement Activities
The performance graph for these categories roll out MIPS final score for the eligible clinicians and get them:
- Positive Payment Adjustments
- Neutral Payment Adjustments
- Negative Payment Adjustments
However, they would be getting these incentives after two years of MIPS data submission. For instance, for MIPS 2021 reporting, successful clinicians would be receiving incentives in 2023.
The Set Penalty Percentage
Like each year, CMS redefines the penalty threshold for the quality payment program (QPP). For the 2021 MIPS Performance year, the penalty percentage is 9%. So, it simply means that if a physician does not perform well in the program, they would be claiming up to 9% of the penalty.
CMS Is Being Considerate of Physicians!
As mentioned above, COVID-19 has been difficult for everyone. And some clinicians have been caught up in the reporting requirements amidst this. For some, they could not even meet each performance category criteria in MIPS 2021 reporting. In such a case, MIPS Qualified Registries come forward as a guiding light to manage your things.
However, even then, clinicians would need assistance to be successful in the Medicare incentive program 2021.
The CMS administration has come up with some updates in this regard. They are teaming up with clinicians to help them avoid negative payment adjustments significantly.
What Does the 2021 Final Rule Say?
In the rulebook of Physician Fee Schedule (PFS) 2021 and the QPP, the participants can enjoy the flexibility of applying for hardship. There will not be any automatic exception in this case. The clinicians can submit an online application for that. In such a case, they can request to exempt them from reporting one or more performance categories. However, it only applies when your medical practice is affected severely by the pandemic.
The Outcomes for the Exception Rule
If a clinician qualifies for the hardship exception rule, CMS will redistribute the affected categories scoring percentage to other categories. Moreover, if all four performance categories are affected for MIPS 2021 reporting, the clinician would be free from any penalty.
However, don’t think of it as a hard and fast rule as even if the clinician qualifies for the exception rule, they still can report MIPS 2021 data.
It is also to consider that if clinicians report even after qualifying for the exemption, their performance score would override the reporting results. For instance, the 2021 reporting hardship exemption would not be valid for the PI category if you reported data for it afterward. So, eligible MIPS participants in 2021 should only report data if they consider being prepared enough to be rewarded.
How Can You Apply for the Hardship Exemption?
CMS is accepting these applications until December 31, 2021. There are no tough requirements. However, just to be on the safe side, you can ask your Qualified Registry to go with the process. The requested information is:
- Why apply for the exception?
- How does the pandemic affect you?
The Facility-Based Scoring
A few months, CMS introduced this option, which might reflect on your 2021 data submission decision.
According to this update:
Eligible healthcare professionals who rendered Medicare professional services up to 75% or more for the following settings will automatically receive points for the “Quality” and “Cost” category through HVBP (Hospital Value-based Purchasing) Program.
- Inpatient hospital
- Emergency room setting
- On-campus outpatient hospital
Given the survey, most emergency clinicians will be using this flexibility. They, and other qualifying physicians, also have the option to report through other quality measures as well for the Quality category. In such reporting style, CMS will consider the highest HVBP and MIPS score automatically.
What Is HVBP Score Status for 2021?
Being ready for the MIPS performance this year, CMS will not gauge the HVBP score for medical practices. So, we do not have any facility-based scoring options. However, clinicians can report in 2021 or apply for the hardship exception rule.
All in all, if you are an eligible clinician and up for participation, you should avail of this opportunity and try to receive incentives and bonuses. Also, when you have exceptional MIPS consultants, the reporting process does not remain hectic. So, pay attention to what partners you choose to generate the best outcomes.