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MACRA/MIPS Updates for 2022

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MACRA/MIPS Updates for 2022

MACRA/MIPS Updates for 2022 March 18, 2022

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) brought about several changes to physician payments for Medicare patients. Most notably, MACRA ended the Sustainable Growth Rate (SGR) formula, which had been negatively affecting those payments. One of the MACRA options for independent physicians is the Merit-based Incentive Payment System (MIPS). There are several MACRA MIPS updates for 2022.

According to the Centers for Medicare & Medicaid Services (CMS), MACRA advances a “forward looking, coordinated framework” for physicians to participate in the Quality Payment Program (QPP) and offers two options for value-based care:

  • MIPS: If you are a MIPS eligible clinician, you will be subject to a performance-based payment adjustment through MIPS.
  • Advanced Alternative Payment Models (Advanced APMs): If you participate in an Advanced APM and achieve QP status, you may be eligible for a 5% incentive payment, and you will be excluded from MIPS.

There are four scoring categories for independent physicians participating in MACRA MIPS. In November 2021, CMS issued its Final Rule for the 2022 Medicare Physician Fee Schedule, which also makes several changes to those categories as well as other aspects of MACRA MIPS for 2022. Those changes include:

Quality Category. Changes have been made to six items: Quality Measures, Data Completeness, Quality Measure Scoring, Bonus Points, Scoring for Groups Reporting Claims Measures, and CMS Web Interface.

Cost Category. The 2022 Final Rules adds five episode-based cost measures for the 2022 performance period.

Improvement Activities Category. CMS has added 7 new activities and modified 15 current activities for the 2022 performance year.

Promoting Interoperability Category. Among the MACRA MIPS updates for 2022 is an automatic reweighting for small practices and clinical social workers, beginning with the 2022 performance period. When this occurs, Quality will be weighted at 40%, Cost will be weighted at 30%, Improvement Activities will be weighted at 30%. In those cases where both the Cost and the Promoting Interoperability performance categories are reweighted, the Quality and Improvement Activities categories will be equally weighted at 50%.

The adjustments for small practices are among the most significant MACRA MIPS updates for 2022. Small practices will have their Promoting Interoperability reweighted and the other categories will be reweighted to reflect: Cost – 30%; Improvement Activities – 30%; and Quality – 40%.

If a small, independent practice reports data for Promoting Interoperability, that category will be scored and the normal weighting will apply. If both the Cost and the Promoting Interoperability categories are reweighted, then the Quality and Improvement Activities categories will be equally weighted at 50%.

The minimum performance threshold has also been finalized for 2022. CMS is required to establish a performance threshold which is either the mean or the medium of all the final MACRA MIPS scores for all eligible providers for a prior performance period beginning with the 2022 performance year. The minimum performance threshold is 75 MIPS points for 2022, which is an increase from 60 MIPS points in 2021. The performance year 2022 will be the last year for an additional MIPS adjustment for exceptional performance, which carries a threshold of 89 points.

CMS states that for physicians who are eligible for MIPS in 2022:

  • They will have to submit data for the quality, improvement activities, and Promoting Interoperability performance categories. (CMS collects and calculates data for the cost performance category.)
  • Their MIPS final score will determine whether they receive a negative, neutral, or positive MIPS payment adjustment.
  • The MACRA MIPS payment adjustment is based on their performance during the 2022 performance year and applied to payments for covered professional services beginning on January 1, 2024.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) brought about several changes to physician payments for Medicare patients. Most notably, MACRA ended the Sustainable Growth Rate (SGR) formula, which had been negatively affecting those payments. One of the MACRA options for independent physicians is the Merit-based Incentive Payment System (MIPS). There are several MACRA MIPS updates for 2022.

According to the Centers for Medicare & Medicaid Services (CMS), MACRA advances a “forward looking, coordinated framework” for physicians to participate in the Quality Payment Program (QPP) and offers two options for value-based care:

  • MIPS: If you are a MIPS eligible clinician, you will be subject to a performance-based payment adjustment through MIPS.
  • Advanced Alternative Payment Models (Advanced APMs): If you participate in an Advanced APM and achieve QP status, you may be eligible for a 5% incentive payment, and you will be excluded from MIPS.

There are four scoring categories for independent physicians participating in MACRA MIPS. In November 2021, CMS issued its Final Rule for the 2022 Medicare Physician Fee Schedule, which also makes several changes to those categories as well as other aspects of MACRA MIPS for 2022. Those changes include:

Quality Category. Changes have been made to six items: Quality Measures, Data Completeness, Quality Measure Scoring, Bonus Points, Scoring for Groups Reporting Claims Measures, and CMS Web Interface.

Cost Category. The 2022 Final Rules adds five episode-based cost measures for the 2022 performance period.

Improvement Activities Category. CMS has added 7 new activities and modified 15 current activities for the 2022 performance year.

Promoting Interoperability Category. Among the MACRA MIPS updates for 2022 is an automatic reweighting for small practices and clinical social workers, beginning with the 2022 performance period. When this occurs, Quality will be weighted at 40%, Cost will be weighted at 30%, Improvement Activities will be weighted at 30%. In those cases where both the Cost and the Promoting Interoperability performance categories are reweighted, the Quality and Improvement Activities categories will be equally weighted at 50%.

The adjustments for small practices are among the most significant MACRA MIPS updates for 2022. Small practices will have their Promoting Interoperability reweighted and the other categories will be reweighted to reflect: Cost – 30%; Improvement Activities – 30%; and Quality – 40%.

If a small, independent practice reports data for Promoting Interoperability, that category will be scored and the normal weighting will apply. If both the Cost and the Promoting Interoperability categories are reweighted, then the Quality and Improvement Activities categories will be equally weighted at 50%.

The minimum performance threshold has also been finalized for 2022. CMS is required to establish a performance threshold which is either the mean or the medium of all the final MACRA MIPS scores for all eligible providers for a prior performance period beginning with the 2022 performance year. The minimum performance threshold is 75 MIPS points for 2022, which is an increase from 60 MIPS points in 2021. The performance year 2022 will be the last year for an additional MIPS adjustment for exceptional performance, which carries a threshold of 89 points.

CMS states that for physicians who are eligible for MIPS in 2022:

  • They will have to submit data for the quality, improvement activities, and Promoting Interoperability performance categories. (CMS collects and calculates data for the cost performance category.)
  • Their MIPS final score will determine whether they receive a negative, neutral, or positive MIPS payment adjustment.
  • The MACRA MIPS payment adjustment is based on their performance during the 2022 performance year and applied to payments for covered professional services beginning on January 1, 2024.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) brought about several changes to physician payments for Medicare patients. Most notably, MACRA ended the Sustainable Growth Rate (SGR) formula, which had been negatively affecting those payments. One of the MACRA options for independent physicians is the Merit-based Incentive Payment System (MIPS). There are several MACRA MIPS updates for 2022.

According to the Centers for Medicare & Medicaid Services (CMS), MACRA advances a “forward looking, coordinated framework” for physicians to participate in the Quality Payment Program (QPP) and offers two options for value-based care:

  • MIPS: If you are a MIPS eligible clinician, you will be subject to a performance-based payment adjustment through MIPS.
  • Advanced Alternative Payment Models (Advanced APMs): If you participate in an Advanced APM and achieve QP status, you may be eligible for a 5% incentive payment, and you will be excluded from MIPS.

There are four scoring categories for independent physicians participating in MACRA MIPS. In November 2021, CMS issued its Final Rule for the 2022 Medicare Physician Fee Schedule, which also makes several changes to those categories as well as other aspects of MACRA MIPS for 2022. Those changes include:

Quality Category. Changes have been made to six items: Quality Measures, Data Completeness, Quality Measure Scoring, Bonus Points, Scoring for Groups Reporting Claims Measures, and CMS Web Interface.

Cost Category. The 2022 Final Rules adds five episode-based cost measures for the 2022 performance period.

Improvement Activities Category. CMS has added 7 new activities and modified 15 current activities for the 2022 performance year.

Promoting Interoperability Category. Among the MACRA MIPS updates for 2022 is an automatic reweighting for small practices and clinical social workers, beginning with the 2022 performance period. When this occurs, Quality will be weighted at 40%, Cost will be weighted at 30%, Improvement Activities will be weighted at 30%. In those cases where both the Cost and the Promoting Interoperability performance categories are reweighted, the Quality and Improvement Activities categories will be equally weighted at 50%.

The adjustments for small practices are among the most significant MACRA MIPS updates for 2022. Small practices will have their Promoting Interoperability reweighted and the other categories will be reweighted to reflect: Cost – 30%; Improvement Activities – 30%; and Quality – 40%.

If a small, independent practice reports data for Promoting Interoperability, that category will be scored and the normal weighting will apply. If both the Cost and the Promoting Interoperability categories are reweighted, then the Quality and Improvement Activities categories will be equally weighted at 50%.

The minimum performance threshold has also been finalized for 2022. CMS is required to establish a performance threshold which is either the mean or the medium of all the final MACRA MIPS scores for all eligible providers for a prior performance period beginning with the 2022 performance year. The minimum performance threshold is 75 MIPS points for 2022, which is an increase from 60 MIPS points in 2021. The performance year 2022 will be the last year for an additional MIPS adjustment for exceptional performance, which carries a threshold of 89 points.

CMS states that for physicians who are eligible for MIPS in 2022:

  • They will have to submit data for the quality, improvement activities, and Promoting Interoperability performance categories. (CMS collects and calculates data for the cost performance category.)
  • Their MIPS final score will determine whether they receive a negative, neutral, or positive MIPS payment adjustment.
  • The MACRA MIPS payment adjustment is based on their performance during the 2022 performance year and applied to payments for covered professional services beginning on January 1, 2024.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) brought about several changes to physician payments for Medicare patients. Most notably, MACRA ended the Sustainable Growth Rate (SGR) formula, which had been negatively affecting those payments. One of the MACRA options for independent physicians is the Merit-based Incentive Payment System (MIPS). There are several MACRA MIPS updates for 2022.

According to the Centers for Medicare & Medicaid Services (CMS), MACRA advances a “forward looking, coordinated framework” for physicians to participate in the Quality Payment Program (QPP) and offers two options for value-based care:

  • MIPS: If you are a MIPS eligible clinician, you will be subject to a performance-based payment adjustment through MIPS.
  • Advanced Alternative Payment Models (Advanced APMs): If you participate in an Advanced APM and achieve QP status, you may be eligible for a 5% incentive payment, and you will be excluded from MIPS.

There are four scoring categories for independent physicians participating in MACRA MIPS. In November 2021, CMS issued its Final Rule for the 2022 Medicare Physician Fee Schedule, which also makes several changes to those categories as well as other aspects of MACRA MIPS for 2022. Those changes include:

Quality Category. Changes have been made to six items: Quality Measures, Data Completeness, Quality Measure Scoring, Bonus Points, Scoring for Groups Reporting Claims Measures, and CMS Web Interface.

Cost Category. The 2022 Final Rules adds five episode-based cost measures for the 2022 performance period.

Improvement Activities Category. CMS has added 7 new activities and modified 15 current activities for the 2022 performance year.

Promoting Interoperability Category. Among the MACRA MIPS updates for 2022 is an automatic reweighting for small practices and clinical social workers, beginning with the 2022 performance period. When this occurs, Quality will be weighted at 40%, Cost will be weighted at 30%, Improvement Activities will be weighted at 30%. In those cases where both the Cost and the Promoting Interoperability performance categories are reweighted, the Quality and Improvement Activities categories will be equally weighted at 50%.

The adjustments for small practices are among the most significant MACRA MIPS updates for 2022. Small practices will have their Promoting Interoperability reweighted and the other categories will be reweighted to reflect: Cost – 30%; Improvement Activities – 30%; and Quality – 40%.

If a small, independent practice reports data for Promoting Interoperability, that category will be scored and the normal weighting will apply. If both the Cost and the Promoting Interoperability categories are reweighted, then the Quality and Improvement Activities categories will be equally weighted at 50%.

The minimum performance threshold has also been finalized for 2022. CMS is required to establish a performance threshold which is either the mean or the medium of all the final MACRA MIPS scores for all eligible providers for a prior performance period beginning with the 2022 performance year. The minimum performance threshold is 75 MIPS points for 2022, which is an increase from 60 MIPS points in 2021. The performance year 2022 will be the last year for an additional MIPS adjustment for exceptional performance, which carries a threshold of 89 points.

CMS states that for physicians who are eligible for MIPS in 2022:

  • They will have to submit data for the quality, improvement activities, and Promoting Interoperability performance categories. (CMS collects and calculates data for the cost performance category.)
  • Their MIPS final score will determine whether they receive a negative, neutral, or positive MIPS payment adjustment.
  • The MACRA MIPS payment adjustment is based on their performance during the 2022 performance year and applied to payments for covered professional services beginning on January 1, 2024.