Healthmonix Advisor

A Summary of the 2019 MIPS Proposed Rule: Part 3

Posted by Christina Zink on July 13, 2018
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Today, CMS posted CY 2019 Updates to the Quality Payment Program to the Federal Register. Many clinicians are still trying to wrap their heads around how to report MIPS in 2018, but the release of the 2019 proposed rule is advantageous in deciding what to conquer both this year and in the future.

Our summary of the proposed rule is separated into three parts. The first part summarized changes to eligibility, the low-volume threshold, the MIPS Determination Period (previously known as the Low Volume Threshold Determination Period), and virtual groups. Second, we took a look at changes to each of the specific performance categories. In our final post we'll investigate changes to the Final Score, and payment adjustment information.


Final Score

Changes to each performance category weight in the final score are listed below:

Year 2 Year 3
Quality: 50% Quality: 45%
Cost: 10% Cost: 15%
PI: 25% PI: 25%
IA: 15% IA: 15%

The small practice bonus will now be added to the Quality performance category, rather than in the MIPS final score calculation. CMS will add 3 points in the numerator of the Quality performance category for MIPS eligible clinicians in small practices who submit data on at least 1 quality measure.


2021 Payment Adjustment

This remains the same as Year 2, except that MIPS eligible clinicians in a group practice who qualify for a group final score will have a modified determination period (a 15 month window that starts with the second 12-month determination period).

A new proposed policy would assign a weight of 0% to each of the four performance categories and a final score equal to the performance threshold, when a MIPS eligible clinician joins an existing practice (TIN) in the final three months of the performance period year and the practice is not participating in MIPS as a group; or, when the practice is a newly formed TIN in the final three months of the performance period year.


Performance Threshold / Payment Adjustment

The Performance Threshold is set at 30 points. An additional performance threshold
Is set at 80 points for exceptional performance. As required by statute, the maximum negative payment adjustment is -7 percent. Positive payment adjustments can be up to 7%, multiplied by a scaling factor.

A Summary of the 2019 MIPS Proposed Rule: Part 1

A Summary of the 2019 MIPS Proposed Rule: Part 2

If you still have questions about MIPS reporting, talk to a member of our quality reporting team, or subscribe to the Healthmonix Advisor for the latest tips and tricks in the world of value based care.


Free eBook: 2019 MIPS Survival Guide

Topics: MACRA & MIPS, Policy