Healthmonix Advisor

No CMS Updates on COVID-19's Impact on MIPS reporting - What it means

Posted by Robert Stoudt on June 18, 2020

MIPS stock photo

In the last couple of weeks, some major changes have been made to the immediate future of Value-Based Care payment models.

Some of these updates include:

  • The extension of the Oncology Care Model (OCM) until June of 2022. The Centers for Medicare & Medicaid Services (CMS) is also giving practices the ability to abdicate downside and upside risk performance during the COVID-19 outbreak.
  • The delay of starting the new Direct Contracting model to April 1st, 2021.
  • The extension of the Next-Gen ACO model until December 2021.
  • The option for participating entities in the Bundled Payments for Care Improvement Advanced (BPCI) payment model  to eliminate upside or downside risk.
  • The removal of COVID-19 episodes of care for certain Medicare ACO models.

Despite these modifications, there is still no word on any potential change to the Merit-Based Incentive Payment program (MIPS). So, what does that mean for MIPS participants? If you have not started, the time to do so is now.   With no official ruling on how COVID-19 will affect the program, we can only speculate on its future.  We do not want you to get penalized for not being prepared.  Are you ready if no changes are made?

Healthmonix remains in weekly communication with representatives of the CMS, in order to deliver the most accurate information to our customers. However, with CMS’s continued silence, it is safe to assume that MIPS reporting, will end up being “business as usual.”

Until there is more guidance from CMS, here are tips on how you should approach your 2020 MIPS reporting:

  • Determine your reporting strategy
    • Consider the impact of reporting  as a group vs. individual, your reporting method and whether to focus on penalty avoidance vs. attacking the incentive
  • Understand the changes to MIPS
    • Know who is eligible, as well as the thresholds and exemptions
  • Choose your measures and start collecting data immediately
    • Avoiding topped out measures, choosing specialty measures and tracking more than six MIPS measures

Some take-aways, based on the current status of MIPS:

A minimum of 45 points are needed to avoid the penalty issued by CMS.  A significant increase from 2019, CMS is making it more difficult to avoid the penalty moving forward.  While the number of points will increase in the future, so will the incentive dollars for MIPS participants to achieve a high score.  The penalized providers will be paying into the system that will incentivize the high achievers.

Know your MIPS measures.  Many of the most common measures have been removed or completely topped out.  Topping out a measure makes it impossible to gain 10 points without being at 100%.  For instance, measures like Documentation of Current Medications, if you are at 99.5% on the measure you will only receive 5 points.  Measure 131, Pain Assessment and Follow Up, has been completely removed. Choosing the right MIPS measures will be more important this year than ever before.

Stay up to date on MIPS 2020.  Tune into our webinar series including our upcoming Advanced MIPS 2020 webinar. View our previous webinars, blog posts and ongoing COVID-19 updates and resources from our MIPS experts. Start tracking and working on your dashboard now. And as always, feel free to reach out to out team of MIPS reporting experts at 888.720.4100 or