The Centers for Medicare and Medicaid Services (CMS) were given until the 2022 performance period/2024 payment period to fully implement the Quality Payment Program (QPP) and its two tracks for participation. These tracks are the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). The government has, for the most part, been successful in finalizing the last of the standards that were mandated by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which was passed in 2015. Let’s take a look at the things that have changed for this performance year, as well as the things that have changed in retrospect for performance years 2020 and 2021 as a result of the public health emergency caused by COVID-19.
Please keep in mind that this is only a brief summary. A more in-depth analysis may be found on the MACRA webpage that is dedicated to the AAPC.
MIPS in 2022
Let’s go through this quickly without going into too much depth, shall we?
MIPS Reporting 2022 is a way for eligible doctors who achieve or surpass a low volume level and are not registered in an Advanced Alternative Payment Model to participate in the Quality Payment Program (QPP). Clinicians who are eligible to engage in MIPS have the option to do so either on their own or as part of a clinician group, virtual group, or both. Clinical social workers and certified nurse midwives have been included on the list of professionals who are qualified to provide care beginning with the calendar year 2022.
By enhancing the health outcomes of Medicare patients, the purpose of the MIPS program is to reduce the overall cost of government spending. This is achieved by providing financial incentives to doctors whose work satisfies predetermined criteria for quality of care is Medicare Supplement Plan G. It will all depend on their participation, as well as the participation of all other MIPS-eligible clinicians, in this budget-neutral incentive payment program. With the payment adjustment rate mandated by MACRA now fully implemented, MIPS-eligible clinicians stand to lose/gain as much as 9 percent in their Medicare Part B claims payments in 2024.
Participation in the MIPS program is evaluated based on how well participants perform in four distinct performance categories: quality, cost, improvement activities, and promoting interoperability. A certain percentage of the total points come from each category. The weights have evolved over the years, and this year is not an exception; they have changed again.
The following are the MIPS performance category weights for the sixth year:
Note: The performance categories will be reweighted as follows for small practices (fewer than 15 clinicians) that are claiming an exception for the Promoting Interoperability category: Quality will receive a score of 40 percent, Cost will receive a score of 30 percent, and Improvement Activities will receive a score of 30 percent. In the event that a small practice asserts that it should be exempt from two performance categories, the other performance categories will each be reweighted to contain an equal amount of weight.
Where Can I Find the Latest Information Regarding the Quality Performance Category?
- In the year 2022, doctors will have access to a total of 200 quality measures, from which they can choose; additionally, there are four high-priority quality measures:
- Bacillus Calmette Guerin administered intravenously for patients with non-muscle invasive bladder cancer
- Hemodialysis Access to the Vascular System at the Practitioner Level Catheterization Rate Over the Long Term
Measurement of Care Focused on the Individual Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions According to Patient Reported Outcome Performance Measure (administrative claims measure with an 18-case minimum for groups with at least 16 clinicians)
Additionally, CMS eliminated 13 previously implemented quality measures and altered 87 others. This year, nine of the updated measures will no longer be eligible for a comparison to a historical benchmark; consequently, the scoring of these measures may be impacted.
During the course of the calendar year, a single clinician, a clinician group, or a virtual group need only gather data on six quality measures (including at least one outcome or high priority measure). Alternatively, a person or organization may report all of the quality measures that are offered in the CMS Web Interface as well as a designated specialized measure set. (Because CMS did not put the finishing touches on its proposal to stop using this collection type, APM entities, virtual groups, and groups that report traditional MIPS can continue to make use of it for this performance year.)
There is no additional credit awarded for reporting additional outcome and high-priority measures in addition to the one that is required, nor is there any additional credit awarded for measures that meet end-to-end electronic reporting criteria. Everyone ought to have been utilizing certified electronic health record technology (CEHRT) with the 2015 edition at this point in time.