What are the MIPS Scoring thresholds for 2020?
Final Score = 45
Exceptional Performer = 80
What happens if I don’t participate in MIPS?
The 2020 performance year of MIPS determines whether or not a +/- 9% adjustment will be applied to my Medicare FFS reimbursement in 2022. Being in private practice, making sure I get the highest payments I can for services is very important for my business, especially if all I have to do is provide care as I normally would and just track a few things to send in at the beginning of 2021. Depending on how well I do, I can also receive part of the $500 million that is still available for disbursement.
How do I know I am eligible?
I check the Quality Payment Program eligibility page. This page is integrated with PECOS and when I enter my NPI, I get a report of all Tax ID numbers (TIN) my NPI is actively associated with and whether or not I am eligible to participate as an individual clinician and/or group.
I like to think of eligibility as a two-step process. First, are the clinicians in my group included on the list of eligible clinicians. Second, do the clinicians meet the low volume threshold for participation.
MIPS Eligible Clinicians
*Represents newly added eligible clinicians in the past 2 years
The low volume threshold is a determination based on a two year look back period to see if I have billed more than $90,000 in Medicare Fee for Services, billed for more than 200 Medicare services, or provided care to more than 200 Medicare beneficiaries. If I meet all three parts of the definition, I am required to participate. If I meet 1 out of the three, I can opt in. If I don’t meet any, I could voluntarily report data.
What is the difference between participating as an individual versus a group?
First, a group is defined as two or more eligible clinicians under the same TIN that have reassigned their billing rights over to the TIN. There is a virtual group definition as well, but I am not going to address that today because there is very little participation in this model.
There are several reasons I can think of for participating as a group versus an individual, but the most important is that it opens the door for all eligible clinicians in the group to receive the positive payment adjustment even if they do not meet the low volume threshold individually. I am all about an opportunity to increase revenue for the practice!
Choosing to participate as a group also means that data from all eligible clinicians, regardless of whether they meet the low volume requirements or not, is considered/must be included for all the MIPS categories the group submits.