MIPS 2020 Payment Adjustments in Effect Based on 2018 Performance

In July 2019, each Merit-based Incentive Payment System (MIPS) eligible clinician received a 2018 MIPS Final Score and associated payment adjustment factor(s) as part of their 2018 MIPS performance feedback, available on the Quality Payment Program website.

2020 MIPS payment adjustments, based on each MIPS eligible clinician’s 2018 MIPS final score, will now be applied to payments made for Part B covered professional services payable under the Physician Fee Schedule. Payment adjustments are determined by the final score associated with your Taxpayer Identification Number (TIN)/National Provider Identifier (NPI) combination.

MIPS eligible clinicians, identified by TIN/NPI combination for the 2018 performance period, will receive a positive, neutral, or negative MIPS payment adjustment in 2020 if they:

Were a clinician type that was included in MIPS;
Enrolled in Medicare prior to January 1, 2018;
Were not a Qualifying Alternative Payment Model (APM) Participant (QP);
Were a Partial Qualifying APM Participant (Partial QP) that elected to participate in MIPS as a MIPS eligible clinician; and
Met one of the following criteria:
- Individually exceeded the low-volume threshold;
- Were in a practice that exceeded the low-volume threshold at the group level submitted group data or were part of an approved virtual group; or
- Were in a MIPS APM and the APM Entity group exceeded the low volume threshold (see footnote below; also includes Partial QPs who elected to participate in MIPS)

For More Information

Review the 2020 MIPS Payment Adjustment Fact Sheet for more details and answers to frequently asked questions.
Visit the Quality Payment Program Resource Library for more Quality Payment Program resources.
For questions, contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, consider calling during non-peak hours—before 10:00 AM and after 2:00 PM ET. We also encourage you to contact us earlier in the year, as response times often increase with heavier demand as the March 31 data submission deadline approaches.
- Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

CMS to Launch New MIPS Participation Framework in 2021 Performance Period

CMS is implementing a new participation framework for the Merit-based Incentive Payment System (MIPS), called the MIPS Value Pathways (MVPs), starting with the 2021 performance period. The goal of this new framework is to move away from siloed performance category measures and activities, and move toward an aligned set of measures and activities that are more meaningful to clinicians and patient care.

With the MVPs framework, we’re aiming to connect measures and activities across the Quality, Cost, Promoting Interoperability, and Improvement Activities performance categories of MIPS for different specialties and conditions.

We believe this new framework will:

Simplify MIPS and reduce clinician burden;
Improve value and create a more cohesive and meaningful participation experience; and
Better align with Alternative Payment Models (APMs) to help ease the transition from MIPS to APMs.

We recognize that this is a significant shift in the way clinicians may potentially participate in MIPS, so we will not immediately eliminate the current MIPS framework. We intend to develop MVPs for 2021 and beyond in collaboration with stakeholders, and we will provide opportunities for dialogue and additional feedback.

For More Information

To learn more, view our MVPs webpage, video, and fact sheet.

Questions?

Contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, consider calling during non-peak hours—before 10 AM and after 2 PM ET.