Will Medicare give you a pay bump next year? Check your MIPS score

It's time to see how you did on your Merit-based Incentive Payment System (MIPS) measures last year and find out whether you're in line for a Medicare cut or raise next year. Physicians and practices can now access their MIPS final score and feedback on the Quality Payment Program (QPP) website.

Performance in 2019 will determine Medicare Part B payments in 2021, with payment adjustments ranging from a 7% decrease to a 7% increase. Practices need to receive a final score of at least 30 points (on a 100-point scale) for 2019 to avoid a negative payment adjustment in 2021. The size of pay raises will be determined by the cumulative total of pay cuts nationally, because MIPS payment adjustments must be budget-neutral overall.

In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) enacted its “extreme and uncontrollable circumstances” policy for the 2019 performance year and automatically applied it to individual clinicians. Individuals who did not submit MIPS data, or only submitted data for one performance category, will automatically receive no payment adjustment. This may limit pay increases, because the program still must be budget-neutral. But those who submitted data for two or more performance categories will receive a final score — and payment adjustment — based on those categories.

CMS did not automatically apply the extreme and uncontrollable circumstances exception to groups and virtual groups, however. They had to apply for it. Groups or virtual groups that were approved to have at least three of the four performance categories reweighted to zero will receive no payment adjustment. Those that were approved for reweighting of one or two performance categories will receive a positive, negative, or neutral payment adjustment based on their performance in the others.

If you believe your final score is incorrect you can request a Targeted Review. Requests must be submitted by 8 p.m. ET on Oct. 5. More information is available in the 2019 Targeted Review User Guide.

MIPS Performance Feedback reports include patient-level data for administrative claims measures (e.g., cost measures), performance on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, scoring updates based on quality measures with performance period benchmarks, 2021 payment adjustment information, and access to request a targeted review.

Additional details on MIPS performance feedback and 2021 payment adjustments is available in the 2019 MIPS Performance Feedback Resources page and 2021 MIPS Payment Adjustment Fact Sheet. You can also contact the QPP Help Desk at 866-288-8292 or QPP@cms.hhs.gov.

A reminder: physicians and practices must apply for the extreme and uncontrollable circumstances exception for the 2020 performance year. CMS will not apply it automatically. Applications and information on COVID-19 flexibilities can be found on the QPP website. Applications are due Dec. 31.

— Erin Solis, Manager of Practice and Payment at the American Academy of Family Physicians