2021 Quality Payment Program Final Rule: What the Biggest Changes Mean if You Report Using MIPS 

Beth Hickerson, Healthcare Transformation Consultant Practice Services

As the year draws to a close, the Centers for Medicare & Medicaid Services (CMS) have given us reason to start looking ahead to 2021: recently, the CMS released the Quality Payment Program (QPP) 2021 Final Rule.   

As many healthcare organizations and practices know, the QPP and the two tracks it creates, the Merit-based Incentive Payment System (MIPS) and the advanced Alternative Payment Models (APMs) have an outsized influence on how organizations are evaluated and reimbursed based on quality of care. Understanding the nuances and newly updated portions of each year’s QPP Final Rule are crucial to maximizing organization performance and reimbursement. So, what’s changed in the 2021 QPP Final Rule?  

Here’s what Medical Advantage’s expert MIPS consultants see as some of the biggest changes to the QPP Final Rule for organizations reporting using MIPS in 2021.  

While changes for clinicians reporting in MIPS as individuals, groups, or virtual groups are minimal in 2021, there are still several to be aware of. The largest and most significant change for these clinicians is that the performance scoring threshold – the minimum MIPS score clinicians must achieve in order not to be penalized – has been raised. Instead of 45 in 2020; in 2021, the minimum performance threshold has been increased to 60. This means that any MIPS score under 60 will now result in a negative payment adjustment. This is important for practices to take note of, as it means that their same level of performance from 2020 may not be sufficient heading into 2021.  

However, the 2021 QPP Final Rule also brings some news that may be more welcome: the planned rollout of the MIPS Value Pathways, a new reporting framework designed to align with clinicians’ specialty and scope of practice, has been delayed until at least 2022, giving practices extra time to prepare and adjust. In addition, as opposed to previous years, there have been relatively few changes to the individual MIPS categories of Quality, Cost, Promoting Interoperability, and Improvement Activities.  

One last thing that organizations scoring using MIPS should note about the 2021 QPP Final Rule: while 2020 and 2021 are confirmed to be scored MIPS years, the CMS has announced that the Extreme and Uncontrollable Circumstances Exception (EUC) for the COVID-19 pandemic will also be extended into 2021, and the deadline for 2020 COVID-19 EUC applications has been extended until February 1st.   

Medical Advantage Can Help with MIPS Reporting 

Understanding the nuances and intricacies of the 2021 QPP Final Rule is crucial to maximizing organization performance and reimbursement. Medical Advantage’s quality experts have over two decades of experience helping healthcare organizations implement best practices, including extensive experience in MIPS and MACRA consulting. Talk to one of our consultants today about how Medical Advantage can help you stay ahead of the curve, master new MIPS requirements in 2021, and boost both care quality and profitability at your practice.  

Talk to one of our MIPS/MACRA Experts Today.