December 2019 MACRA Minute

December 2019 Happy Holidays!
We hope you’re able to enjoy quality time with friends and family this holiday season!

Now Available: 2020 Quality Measures List

CMS recently published the quality measures list for 2020. This comprehensive list contains the measure description, collection type, and specialty measure set name. Technical measure specifications and supporting documents for the 2020 measures will be posted prior to the start of the performance year.


Take Action: Check Your 2019 MIPS Eligibility Status

ECs can now check the QPP Participation Status Tool for their final 2019 MIPS eligibility status. Initially, CMS determined 2019 eligibility status using Part B claims and PECOS data from 10/1/2017 to 9/30/2018 2018. This has now updated  based on CMS’ latest review of Part B claims/PECOS data from 10/1/2018 to 9/30/2019.

Please Note: If you joined a new practice (meaning previously billed under a different TIN) between 10/1/2018 to 9/30/2019, your eligibility will reflect your association with the new practice.

Those joining a new practice after 9/30/2019, are not be eligible to report MIPS data as an individual that’s associated with your new practice. However, you might be eligible to receive a payment adjustment if your new practice elects to participate as a group.

For More Information:

Check out the 2019 participation and eligibility fact sheet and user guide


Reminder: CMS Final Policies for PY 2020

On November 1, CMS issued final policies for QPP performance year 2020 of the via the  Medicare Physician Fee Schedule Final Rule.

Key finalized policies include:

  • Maintaining weights for the Cost (15 percent) and Quality (45 percent) performance categories
  • Increasing the performance threshold from 30 points to 45 points
  • Increasing the data completeness threshold (quality data that clinicians submit) to 70 percent 
  • Increasing the participation threshold for group reporting in the Improvement Activity category from a single clinician to 50 percent of clinicians in the practice
  • Revising the specifications for the Total Per Capita Cost and Medicare Spending Per Beneficiary Clinician measures
  • Updating requirements for Qualified Clinical Data Registry measures and services third-party intermediaries must provide (beginning in PY 2021)

CMS is finalizing the MIPS Value Pathways participation framework that begins in PY 2021. MVPs will move away from siloed activities and measures toward measure options that are more relevant to the clinician’s practice and patients under their care. CMS will implement the MVP framework gradually, beginning in PY 2021.

For more information please reference the following documents:

  • Fact Sheet comparing requirements in PY 2020 to PY 2019
  • FAQs regarding 2020 final rule policies
  • MVPs Video of the MVPs participation framework

2020 Quality Payment Program Final Rule Webinar


Act Now: PI Hardship Applications Due December 31, 2019

ECs struggling to meet requirements for the Promoting Interoperability category can apply for a hardship exception by December 31, 2019, citing one of the following specified reasons:

  • Small practice
  • Decertified EHR technology
  • Insufficient internet connectivity
  • Extreme and uncontrollable circumstances such as disaster, practice closure, severe financial distress or vendor issues
  • Lacking control over the availability of CEHRT

Please note:

  • Simply lacking CEHRT does not qualify you for re-weighting
  • ECs already exempt from Promoting Interoperability don’t need to apply 

If you have questions about the hardship exceptions, please refer to the 2019 exceptions FAQ document


Register Now: CMS Webinars

December 2019 LAN Webinar: Implications for the Year 4 Final Rule


New Resources Available in the QPP Library

The following resources were updated or added in November:

We anticipate 2020 resources will be available in early January. If you haven’t already done so, sign up for the CMS QPP listserv.  


Quality Measures Tip: 2020 Measures and Activities

In 2020, this section of the newsletter will provide an in-depth look at new measures and activities for 2020 including three new quality measures and two new Improvement Activities.

Quality Measures:

  • 476: International Prostate Symptom Score or American Urological Association-Symptom Index Change 6-12 Months After Diagnosis of Benign Prostatic Hyperplasia
  • 477: Multimodal Pain Management
  • 478: Functional Status Change for Patients with Neck Impairments

Improvement Activities:

  • IA_BE_25: Drug Cost Transparency High Weight
  • IA_CC_18: Tracking of clinician’s relationship to and responsibility for a patient by reporting MACRA patient relationship codes

This material was prepared by Telligen QPP-SURS Resource Center, the Quality Payment Program for Iowa, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. HHSM-500-2017-00012C.

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