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2021 MIPS Quality Measure Updates

by | Feb 9, 2021

At the end of each year, the Centers for Medicare & Medicaid Services (CMS) release final regulations for the Quality Payment Program for the coming year. The regulations include updates to the approved quality measures.

The 2021 regulations are now available, but a concise summary of the quality measure changes can be hard to find, so our MIPS Consultants at Medical Advantage have created quick reference guides for MIPS 2021 Quality Measure changes for practices.

Why provide a free MIPS Quality Measure resource?

Over the past few years, Medical Advantage has helped 1,200 clinicians exceed the national average in MIPS scores, with 99% achieving exceptional performer status with CMS. We would love to add your practice to our list of clients, who benefit from our personalized one-on-one support.

These downloadable documents include five resources for 2021 MIPS Quality Measures:

1. MIPS 2021 Quality Measures – New Measures

These new MIPS quality measures are available for reporting for the first time in 2021. Since these quality measures have not been reported before, CMS does not have historical data to use for benchmarking. A clinician or group reporting one of these quality measures will initially earn 3 points for the measure, assuming the data completeness criteria are met. If enough clinicians or groups report the measure for 2021, CMS may be able to create benchmarks based on performance year data. In that case, reporting clinicians or groups may earn more than 3 points, depending on their performance compared to others who report the measure.

Medical Advantage’s MIPS Consultants recommend that practices report new measures as additional measures, rather than as one of their top six required measures, since scoring for new measures will be unpredictable. Also, keep in mind that since these measures are new, EHR vendors may not be able to build specifications quickly enough to make these CMS quality measures available for 2021 CMS quality reporting.

2. MIPS 2021 Quality Measures – Deleted Measures

These are MIPS quality measures that CMS has removed from the MIPS quality reporting program. If a clinician or group reported any of these deleted measures in 2020 as one of their six required quality measures, they will need to choose a replacement measure for 2021.

3. MIPS 2021 Quality Measures – Topped Out Measures

These quality measures have an overall performance rate so high that meaningful distinctions and improvements in performance can no longer be made. CMS has a multi-year phase-out cycle for topped-out quality measures, which includes a 7-point cap for measures that have been classified as topped-out for two or more consecutive years. A clinician who reports a topped-out measure with a 7-point cap will score no more than 7 points for that measure, even if they report a perfect 100% performance rate. Clinicians and groups are encouraged to report topped-out measures with a 7-point cap only as additional measures above the required six measures, for maximum scoring potential.

4. MIPS 2021 New Improvement Activities

CMS has only added 1 new activity to Improvement Activities for Year 5, and the activity is in response to the COVID-19 pandemic. As a reminder, physicians must achieve a total of 40 points from Improvement Activities during a 90-day reporting period. CMS will score activities as either high- or medium-weighted. High-weighted activities are worth 20 points, while medium-weighted activities are worth 10 points. Certain clinician types, such as those in small practices, automatically receive double the assigned points for their Improvement Activities.

5. MIPS 2021 Deleted Improvement Activities

Only 1 of the Improvement Activities has been removed from the list of available options for 2021. Reasons for Improvement Activity removal include reduction of duplicative activities, alignment with current best practice clinical guidelines and meaningful measure areas, and lack of utilization in prior MIPS reporting years.

With MACRA constantly changing from year-to-year, it can be challenging for practices to keep up. Now is a great time to consider hiring consultants like Medical Advantage’s MIPS Consultants. Our MIPS consultants have years of experience working as practice managers, nurses, and billing specialists. With our full-time focus and devotion to this program, we can offer insights to help your practice succeed in MACRA for 2021 and beyond. Over the past few years, we helped 1,200 clinicians exceed the national average in MIPS scores, with 99% achieving exceptional performer status with CMS. Get in touch today for a free consultation to find out how our services can support your practice!

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