December 2021 MACRA Minute

CMS Publishes 2022 PFS Final Rule for the Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) published the CY 2022 Medicare Physician Fee Schedule (PFS) Final Rule, which includes the final policies for the 2022 performance year of the Quality Payment Program (QPP). The rule affects traditional MIPS, MIPS Value Pathways (MVPs), the APM Performance Pathway (APP), Advanced APMs, and the Medicare Shared Savings Program (Shared Savings Program).

2022: QPP Final Rule Highlights

Key QPP policies in the 2022 performance year include:

  • Revising the definition of a MIPS eligible clinician to include social workers and certified nurse mid-wives.
  • Setting the MIPS performance threshold at 75 points and the exceptional performance threshold at 89 points.
  • Weighting the cost and quality performance categories equally (as statutorily required) at 30%.
  • Extending the CMS Web Interface as a collection type and submission type in traditional MIPS for registered groups, virtual groups, and APM Entities for the 2022 performance year only.
  • Finalizing a longer transition for electronic clinical quality measures (eCQMs)/MIPS clinical quality measures (CQMs) measure reporting for Shared Savings Program Accountable Care Organizations (ACOs) by extending the CMS Web Interface as an option for 3 years (through the 2024 performance year).

2023 and Beyond: QPP Final Rule Highlights – Additional Finalized Policies

The following updates were also included in the PFS Final Rule and affect future years of the QPP:

  • Finalizing 7 MVPs that will be available, beginning with the 2023 performance year.
  • Providing a description of the registration process and timeline for MVP and subgroup registration, beginning with the 2023 performance year.

For More Information

To learn more about the CY2022 PFS Final Rule and all of the 2022 QPP finalized policies, please review the following resources:

  • Press Release: Provides additional details regarding the announcement.
  • QPP 2022 Final Rule Resources Zip FileContains the following:
  • Overview Fact Sheet: Offers an overview of the QPP Final Rule policies for the 2022 performance year.
  • Policies Comparison Table: Compares the final 2022 performance year policies to the requirements for the 2021 performance year.
  • MVP Policies Table: Provides an overview of the policies for implementation of MVPs beginning in the 2023 performance year.
  • Frequently Asked Questions (FAQs): Addresses the FAQs for the 2022 QPP Final Rule policies.

Questions

Contact the Quality Payment Program at 1-866-288-8292 (Monday-Friday, 8 a.m.- 8 p.m. ET) or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, consider calling during non-peak hours—before 10 a.m. and after 2 p.m. ET. Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.


CMS to Apply MIPS Automatic Extreme and Uncontrollable Circumstances Policy for the 2021 Performance Year in Response to COVID-19 Public Health Emergency

The Centers for Medicare & Medicaid Services (CMS) continues to provide relief where possible to clinicians responding to the 2019 Coronavirus (COVID-19) public health emergency (PHE). CMS is applying the Merit-based Incentive Payment System (MIPS) automatic extreme and uncontrollable circumstances (EUC) policy to ALL individually eligible MIPS eligible clinicians for the 2021 performance year (PY). Please note that this announcement is for PY2021 only.

The automatic EUC policy only applies to MIPS eligible clinicians who are eligible to participate in MIPS as individuals. The automatic EUC policy doesn’t apply to groups, virtual groups, or Alternative Payment Model (APM) Entities.

Learn what this means for you below.

MIPS eligible clinicians who are eligible to participate in MIPS as individuals

You don’t need to take any action to have the automatic EUC policy applied to you. You’ll be automatically identified and will have all 4 MIPS performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless you 1) submit data in 2 or more performance categories, or 2) have a higher final score from group or APM Entity participation. 

Small practices reporting Medicare Part B claims measures

Under current policies, CMS automatically calculates a quality score from Medicare Part B claims measures at the individual and group level.

  • Clinicians in small practices that report Medicare Part B claims measures who are only eligible to participate in MIPS as part of a group aren’t covered by the automatic EUC policy and will receive the group’s final score. (To identify these clinicians, sign in to qpp.cms.gov, navigate to the “Eligibility & Reporting” page and click “View Clinician Eligibility”. Clinicians who are only eligible to participate as part of a group will have a green check mark next to “Group”; there won’t be a green check mark next to “Individual”.)
  • Some small practices may not be aware of the implications of their PY 2021 claims reporting due to some of the policies introduced at the onset of the COVID-19 PHE.
  • As a result, these small practices may wish to request performance category reweighting on behalf of the group through the PY2021 EUC Exception Application, citing COVID-19 as the triggering event.
  • PY2021 EUC Exception Applications can be submitted by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation.

Groups

The automatic EUC policy doesn’t apply to groups. You don’t need to take any further action if you’re not able to submit data for the 2021 performance year. Group participation is optional (specific guidance for small practices noted above), and your individually eligible MIPS eligible clinicians qualify for the automatic EUC policy if you don’t report at the group-level on their behalf. (If you submit data at the group level on behalf of your MIPS eligible clinicians, the group will receive a MIPS final score based on the data submitted.) Your MIPS eligible clinicians will have all 4 performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless 1) they submit data in 2 or more performance categories, or 2) they have a higher final score from group or APM Entity participation. 

Virtual Groups

MIPS eligible clinicians in a virtual group will receive a payment adjustment based on the virtual group’s final score, even if no data is submitted. (When no data is submitted for the virtual group, the MIPS eligible clinicians in the virtual group could receive the maximum negative payment adjustment of -9% in the 2023 payment year.)

  • If you’re unable to submit data for the 2021 performance year as a result of the ongoing COVID-19 PHE, you can submit a PY2021 EUC Exception Application on behalf of the virtual group, citing COVID-19, to request reweighting for all 4 performance categories.
  • PY2021 EUC Exception Applications can be submitted by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation through December 31, 2021.

APM Entities

The automatic EUC policy doesn’t apply to APM Entities. You don’t need to take any action if you’re not able to submit data for the 2021 performance year. APM Entity participation is optional (specific guidance for small practices noted above), and your individually eligible MIPS eligible clinicians will have the automatic EUC policy applied to them if you don’t report at the APM-Entity level on their behalf. (If you submit data at the APM-Entity level on behalf of your MIPS eligible clinicians, the APM Entity will receive a MIPS final score based on data submitted.) Your MIPS eligible clinicians will have all 4 performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless 1) they submit data in 2 or more performance categories, or 2) they have a higher final score from group or APM Entity participation. 

If your APM Entity would like to request performance category reweighting for the 2021 performance year, you must submit an EUC application.

  • PY2021 EUC Exception Applications can be submitted by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation through December 31, 2021.

Medicare Shared Savings Program ACOs

The MIPS Automatic EUC policy doesn’t apply to Shared Savings Program Accountable Care Organizations (ACOs). ACOs can submit a PY2021 EUC Exception Application on behalf of its MIPS eligible clinicians if they are unable to report via the Alternative Payment Model (APM) Performance Pathway (APP). To submit a PY2021 EUC Exception Application, ACOs must demonstrate that greater than 75% of its MIPS eligible clinicians would be eligible for reweighting the Promoting Interoperability performance category. ACOs can submit PY2021 EUC Exception Applications by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation through December 31, 2021.

Note: The Shared Savings Program Quality EUC policy for determining shared savings and losses applies to all Shared Savings Program ACOs for performance year 2021. CMS considers all ACOs to be affected by the COVID-19 PHE and the Shared Savings Program EUC policy applies for PY2021. ACOs that are able to report quality data via the APP and meet MIPS data completeness and case minimum requirements will receive the higher of their ACO quality score or the 30th percentile MIPS quality performance category score. ACOs that are unable to report quality data via the APP and meet the MIPS quality data completeness and case minimum requirements, will have their quality score set equal to the 30th percentile MIPS quality performance category score.

Additional Resources

For more information, please see the Quality Payment Program COVID-19 Response webpage on the QPP website. You can contact the Quality Payment program at 1-866-288-8292 (TRS: 711), Monday through Friday, 8AM-8PM ET or by e-mail at: QPP@cms.hhs.gov.


Check Final 2021 MIPS Eligibility Status

You can now visit the Quality Payment Program (QPP) Participation Status Tool and review your final 2021 eligibility status for the Merit-based Incentive Payment System (MIPS). The Centers for Medicare & Medicaid Services (CMS) updated your eligibility status based on the review of Medicare Part B claims and Medicare Provider Enrollment, Chain, and Ownership System (PECOS) data from the second segment of the MIPS Eligibility Determination Period (October 1, 2020 – September 30, 2021).

  • This status is final unless you participate in an Advanced Alternative Payment Model (APM) and your Qualifying APM Participant (QP) status changes as a result of the 3rd APM Snapshot for performance year 2021.
  • Results from the 3rd APM Snapshot will be available in December 2021 and will be announced through the QPP listserv.

Review Your 2021 Eligibility

Your status may have changed, so CMS encourages you to use the QPP Participation Status Tool to confirm your final 2021 MIPS eligibility status.

If, after a review of the data from the first segment of the MIPS Eligibility Determination Period (October 1, 2019 – September 30, 2020), you were determined to be:

  • Eligible for MIPS: Your eligibility status could have changed, and you may no longer be eligible. You should use the tool to make sure you’re still eligible.
  • Not eligible for MIPS at a particular practice: Your eligibility status, based on your association with that particular practice, didn’t change.

Please note, if you joined a new practice (meaning you billed under, or assigned your billing rights to, a new or different Tax Identification Number (TIN)) between October 1, 2020, and September 30, 2021, CMS evaluated your MIPS eligibility status based on your association with that new practice (identified by TIN) for this second review.

If you’re a clinician that joined a new practice after September 30, 2021, you aren’t eligible for MIPS as an individual based on your association with that new practice (identified by TIN). However, you may be eligible to receive a MIPS payment adjustment based on your group’s participation, if the new practice you joined chooses to participate in MIPS as a group.

For More Information

Please visit the MIPS Participation Options Overview webpage on the Quality Payment Program website and check out the following resources:


MIPS Low-Volume Threshold Criteria for 2021 and Participating Through the Opt-In or Voluntary Reporting Options

Clinicians and groups are excluded from MIPS for 2021 if they:

In order to be eligible for MIPS, a clinician or group must exceed all 3 criteria listed above. You can check the Quality Payment Program (QPP) Participation Status Tool to view your final 2021 eligibility status for MIPS.

Participation Options for Clinicians and Groups Not Eligible for MIPS

Clinicians and groups who aren’t eligible for MIPS can still report data via traditional MIPSClinicians and groups who are identified as “opt-in eligible” on the QPP Participation Status Tool have exceeded 1 or 2 of the low-volume threshold criteria noted above and have at least one clinician who:

  • Is identified as a MIPS eligible clinician type on Medicare Part B claims;
  • Enrolled as a Medicare provider before 2021; and
  • Isn’t a QP.

Opt-in eligible clinicians and groups who wish to report data via traditional MIPS can:

  • Elect to Opt-in to MIPS. You’ll receive a MIPS payment adjustment (positive, negative or neutral).
  • Note: Once you make your election, your election is binding and irreversible.
  • Voluntarily Report. You won’t receive a MIPS payment adjustment (no election is required to voluntarily report data to MIPS).

Clinicians and groups who are excluded from MIPS and aren’t “opt-in eligible” because they fall below all 3 of the low-volume threshold criteria may choose to voluntarily report data to MIPS but won’t receive a MIPS payment adjustment.

Note: MIPS APM Participants who are “opt-in” eligible also have the option to elect to opt-in and report using the APM Performance Pathway (or APP).

Next Steps

Before reporting data, opt-in eligible clinicians and groups who wish to submit data will need to complete an election to opt-in or voluntarily report in MIPS by signing in to the QPP website. Qualified Registries and Qualified Clinical Data Registries (QCDRs) can also submit elections on behalf of these clinicians and groups. Elections can be made once the 2021 MIPS submission period opens on January 3, 2022.

For More Information

Visit the Reporting Options Overview webpage on the Quality Payment Program website. The 2021 MIPS Opt-In Reporting and Election Process Toolkit will be available on the QPP Resource Library by the start of the submission period.


Check Your Initial 2022 MIPS Eligibility on the QPP Website

You can now use the Quality Payment Program Participation Status Tool to check your initial 2022 MIPS eligibility status.

  • Just enter your National Provider Identifier (NPI) to find out whether you need to participate in MIPS during the 2022 performance year.

Low-Volume Threshold Requirements

To be eligible to participate in MIPS in 2022, you must:

  • Bill more than $90,000 a year in allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS); AND
  • Furnish covered professional services to more than 200 Medicare Part B beneficiaries; AND
  • Provide more than 200 covered professional services under the PFS.

If you don’t exceed all 3 of the above criteria for the 2022 performance year, you’re excluded from MIPS. However, you have the opportunity to opt-in to MIPS and receive a payment adjustment if you meet or exceed 1 or 2, but not all, of the low-volume threshold criteria. Alternatively, you may choose to voluntarily report to MIPS and not receive a payment adjustment

if you don’t meet any of the low-volume threshold criteria or if you meet some, but not all, of the criteria.

Please note, CMS now evaluates the low-volume threshold for MIPS Alternative Payment Model (APM) participants at the individual or group level, just as it does for participants who aren’t in MIPS APMs. CMS no longer evaluates APM Entities for eligibility against the low-volume threshold.

Find Out Today

Find out today whether you’re eligible for MIPS. Prepare now to earn a positive payment adjustment in 2024 for your 2022 performance.

Note: The QPP Participation Status Tool will be updated with clinicians’ QP status 3 times during the performance year.

Questions?

Please contact the Quality Payment Program at 1-866-288-8292 (Monday-Friday 8 a.m.- 8 p.m. ET) or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, consider calling during non-peak hours—before 10 a.m. and after 2 p.m. ET. Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.


Doctors and Clinicians: Don’t forget to preview your performance information

The Centers for Medicare & Medicaid Services (CMS) opened the Doctors and Clinicians Preview Period on November 15, 2021. The Preview Period provides an opportunity for doctors and clinicians to review their 2020 Quality Payment Program (QPP) performance information before it’s publicly reported on clinician and group profile pages on Medicare Care Compare and in the Provider Data Catalog (PDC)

You can access the secured Preview through the QPP website.

Please refer to the resources below on how to preview your information:

For additional assistance with accessing the QPP website or obtaining your HARP user role, contact the QPP Service Center at QPP@cms.hhs.gov. You can also use this toolkit to learn how to register with HARP.

To learn more about the 2020 QPP performance information that’s available for preview as well as the 2019 clinician utilization data that will be added to the PDC, download these documents from the Care Compare: Doctors and Clinicians Initiative page:

Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organizations (ACOs) and Next Generation Model ACOs can preview their performance information via their 2020 MIPS Performance Feedback Reports. Shared Savings Program ACOs can also review quality performance information on their previously provided 2020 Quality Performance Reports. A list of ACO performance information targeted for public reporting is available on the Care Compare: Doctors and Clinicians Initiative page in the downloadable 2020 ACO Performance Information document. ACO level data isn’t available for viewing during the Preview Period.

The Preview Period will close on December 14, 2021 at 8 p.m. ET (5 p.m. PT).

Please note the 2020 QPP performance information is targeted for public reporting in 2022 and will be added to Care Compare and/or the PDC after all targeted reviews are completed. If you have an open targeted review request, you’ll still be able to preview your 2020 QPP performance information during the Doctors and Clinicians Preview Period.

If you have any questions about public reporting for clinicians on Care Compare, contact the QPP Service Center at 1-866-288-8292 (Monday-Friday 8 a.m. – 8 p.m. ET) or by e-mail at QPP@cms.hhs.gov. To receive assistance more quickly, consider calling during non-peak hours (before 10 a.m. and after 2 p.m. ET). Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.


Now Open: Virtual Group Election Period for the MIPS 2022 Performance Year

If you’re interested in forming a virtual group for the 2022 Merit-based Incentive Payment System (MIPS) performance year, the election period opened October 1, 2021. To form a virtual group, an election must be submitted to CMS via e-mail between October 1, 2021and December 31, 2021 (11:59 p.m. ET)

NOTE: A virtual group must submit an election to CMS for each performance year that it intends to participate in MIPS as a virtual group (as required by statute). If your virtual group was approved for the 2021 MIPS performance year and intends to participate in MIPS as a virtual group for the 2022 MIPS performance year, your virtual group is still required to submit an election to CMS for the 2022 MIPS performance year between October 1, 2021, and December 31, 2021 (11:59 p.m. ET)

What Is a Virtual Group?

A virtual group is a combination of 2 or more Taxpayer Identification Numbers (TINs) consisting of the following:

  • Solo practitioners who are MIPS eligible (a solo practitioner is defined as the only clinician in a practice); and/or
  • Groups that have 10 or fewer clinicians (at least one clinician within the group must be MIPS eligible). A group is considered to be an entire single TIN.

A virtual group has the flexibility to determine its own makeup. A solo practitioner or group can only participate in one virtual group during the performance year. 

What Are the Advantages of Participating in a Virtual Group?

Participating in MIPS as a virtual group has the following advantages:

  • Can increase performance volume in order to be reliably measured; and
  • Provides an opportunity for members of a virtual group to collaborate, share resources, and potentially increase performance under MIPS.

What Is the Virtual Group Election Process?

The following highlights key items that a virtual group needs to complete prior to the submission of an election:

  • Establish a formal written agreement between each TIN within the virtual group (see Agreement Sample Template in the Virtual Group Election Process Guide within the 2022 Virtual Group Toolkit).
  • Identify an official virtual group representative.

The following outlines the elements that need to be included in an election:



  • Acknowledgement that a formal written agreement has been established between each TIN within the virtual group.
  • The name and contact information for the official virtual group representative.
  • The name and TIN for each practice, and all associated National Provider Identifiers (NPIs) under each TIN.

Once complete, the virtual group must submit the election via e-mail to CMS at MIPS_VirtualGroups@cms.hhs.gov by 11:59 p.m. ET on December 31, 2021 (see Election E-mail Sample in the Virtual Group Election Process Guide within the 2022 Virtual Group Toolkit).

For further information regarding virtual group participation in MIPS, virtual group reporting requirements, the election process, checklists for virtual groups to consider, and sample templates, download the 2022 Virtual Group Toolkit.

Need Help?

Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, please consider calling during non-peak hours—before 10 a.m. and after 2 p.m. ET. Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.


December Telligen QPP Connect Live Call

There will NOT be a Telligen QPP Connect Live call in December. Please join us on Wednesday, January 19, 2022, at noon CST for the last QPP Connect Live Call. Topic will be announced in the January MACRA Minute newsletter.


CMS Webinars

December 7 MVPs Development Kick-Off Webinar

The Centers for Medicare & Medicaid Services (CMS) is hosted a webinar on Tuesday, December 7 from 12:30 – 2:00 p.m. ET to provide an overview of MIPS Value Pathways (MVPs) development for the 2023 performance year of the Quality Payment Program and beyond.

During the webinar, CMS subject matter experts:

  • Summarized new criteria for MVPs development and provide updates to the MVP guiding principles as detailed in the 2022 Quality Payment Program Final Rule;
  • Reviewed timeline updates for MVPs creation and rollout; and
  • Outlined the process stakeholders should follow for submitting an MVP candidate for consideration through the CMS MVP Submission Template.

Stakeholders interested in submitting an MVP candidate to CMS for consideration may download the MVP Submission Template by clicking here or visiting the QPP Resource Library. For more information about finalized MVP policies, please review the following resources:

Webinar Details

Title: 2023 MVPs Development Kick-Off Webinar

Date: Tuesday, December 7, 2021

Time: 12:30 – 2:00 p.m. ET

Please note: Participants will have the option to listen to the webinar by dialing in on the phone or listening though their computer speakers. If you are having issues connecting to the webinar audio, please contact CMSQualityTeam@ketchum.com.

Reminder

You can view previous CMS webinars on various MIPS categories/topics in the Webinar Library on the QPP website. The slide deck for the Overview of the 2022 Quality Payment Program Final Rule rescheduled webinar is now available.


Telligen Webinars

Our monthly webinar for November was an open forum to call in and ask any questions related to MIPS. The Telligen QPP SURS team held Office Hours to answer any MIPS-related questions from the audience as well as share some timely reminders about filing targeted reviews for 2020 or extreme and uncontrollable circumstances exception applications for 2021.You can view the recording or download the slides from our website.



In conjunction with the QPP Multi-State Office Hour session, the MIPS in 2022: Prepare Now webinar was presented on November 18. The panelists presented steps you can take now to prepare for MIPS in 2022. Small practice considerations, as well as direction on where you will get help for MIPS in the future, were highlighted. The recording can be found at QPP Multi-State Office Hour session – Zoom.


New Resources in the QPP Resource Library

The following resources were updated or added in November:

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