Highlights of Quality Payment Program Year 5:

The Quality performance threshold has been raised from 45 points to 60 points.

A MIPS score of 60 avoids negative adjustment; a score of 85+ earns the exceptional performance bonus.

Practices who plan to submit Improvement Activities as a group must now attest that at least 50% of the group participated in the submitted activities.

No changes to the policies for small and rural or non-patient facing practices.

Minor changes to category weights; Quality has been lowered to 40% and Cost raised to 20%.

We have seen some of our small clients join Alternative Payment Models (APMs), sharing the reporting risk with other providers for an opportunity for a 5% incentive.

The last CMS announcement for the Sequestration has the suspension expiring 3/31/21, under the “Medicare Sequester Covid Moratorium Act”, passed in connection with the CARES Act  .

Some Senators and medical organizations are urging Congress to once again include the “Medicare Sequester Covid Moratorium Act”, extending through the end of 2021 as part of the American Rescue Plan Act 2021.

Hopefully providers will see this suspension continue if and when the stimulus package is passed..

FYI the additional 4 percent reduction would not take effect until 2022. So once legislation is passed I will look to see what the result is for the additional cut. Apparently this is something that has been on the books as “PAYGO” plan, a budget rule requiring that tax cuts and mandatory spending increases must be offset (i.e., “paid for”) by tax increases or cuts in mandatory spending.

Learning way more about government spending than I ever thought I would.

Michele Krpata, BSW, CPC, CPMA

Compliance Officer, Quality Reporting Analyst