January 9, 2020

MIPS Updates for the New Year

Although I recently wrote about the upcoming policy changes to the Merit-based Incentive Payment System (MIPS), the major quality reporting program for physicians under Medicare, the Centers for Medicare & Medicaid Services (CMS) just made some other important announcements about the program that you should know about.

CMS released final 2018 performance results that confirm the preliminary results I’ve previously shared with you. Remember, your performance during 2018 affects your Medicare reimbursement this year. The vast majority of clinicians (98 percent) performed well in MIPS in 2018 and are eligible for a positive payment adjustment in 2020. Since MIPS is a budget neutral program—meaning CMS uses penalties to pay bonuses—and only a small percentage of clinicians will receive penalty, the largest possible bonus you can receive in 2020 is just 1.68 percent. Basically, if you received a perfect MIPS score in 2018, each of your Medicare professional claims in 2020 will be increased by 1.68 percent.

If you’re asking yourself if it’s worth going through the effort of participating in MIPS if the maximum bonus is less than 2 percent, my answer is YES! If you don’t report, the penalty grows to a 9 percent reduction to your Medicare payments.

In the long run, you’re likely to be better awarded for your efforts. CMS raised the bar in 2019 and is continuing to institute more difficult requirements in 2020 and 2021 that will cause more clinicians to receive a negative payment adjustment, thereby increasing the pool of bonuses that are potentially available for clinicians who successfully perform in the program.

Speaking of 2019, CMS also recently announced that you can start reporting your 2019 performance data through March 31st. To report data:

  1. Go to the Quality Payment Program (QPP) website
  2. Sign in using your QPP access credentials (you must have a username and password)
  3. Submit your MIPS data or review the data reported on your behalf by a third party (such as ACEP’s qualified clinical data registry, the Clinical Emergency Data Registry or CEDR)

If you have questions about reporting, please contact the Quality Payment Program at 1-866-288-8292 or

Lastly, CMS announced that you can check your eligibility for MIPS reporting in 2020. Go to the CMS Quality Payment Program Participation Status Lookup Tool and enter your National Provider Identifier, or NPI. You can find out more about general MIPS eligibility rules here.

Now you know the latest on MIPS! Don’t wait to report your 2019 data until the last minute (remember the deadline is March 31st!) and get prepared to start meeting the 2020 reporting requirements (click here for my tips on 2020 reporting).

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!

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