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2018 MIPS Final Scores Impacting 2020 Medicare FFS Payments Now Available

July 09, 2019

McDermott+Consulting

The Centers for Medicare and Medicaid Services (CMS) released final scores for the 2018 Merit-based Incentive Payment System (MIPS). An eligible group or individual clinician’s performance in the 2018 MIPS program will result in upward, downward or neutral payment adjustments to 2020 Medicare Part B payments for covered professional services.

While by statute the maximum positive adjustment for 2020 is five percent, in reality the maximum positive payment adjustment may be less. MIPS is a budget neutral program, which means that the projected negative adjustments must be balanced by the projected positive adjustments. If many participants are successful, the distribution of positive payment adjustments is spread across many more people, reducing the actual adjustment.

MIPS eligible clinicians and individual clinicians may view their reports on the Quality Payment Program website. The reports contain feedback related to a clinician’s (or group’s) 2018 MIPS performance. That feedback includes the 2018 final score, 2020 MIPS payment adjustment, and final performance category scores and weights.   If a participant feels that there is an error in the report, they may request a targeted review. A targeted review can be requested until September 30, 2019 through the Quality Payment Program website. The Targeted Review Fact Sheet is available here and the 2018 Targeted Review FAQs is available here.

Clinicians who participated in MIPS Alternative Payment Model (APM) entities (including Next Generation Accountable Care Organizations (ACO), Comprehensive Primary Care Plus and Medicare Shared Savings Program ACO) can also view their performance feedback. Individual clinicians and representatives of the APM Entity will be able to access performance feedback directly on the Quality Payment Program website using their HARP account.

 


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459 or smadhani@mcdermottplus.com.

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