The pandemic has caused everyone to alter their behavior in all facets of life. MIPS is no exception. However, we have closely followed changes in the MIPS regulations as CMS made adjustments in response to the ongoing pandemic. This close review has allowed us to develop creative ways to minimize the MIPS reporting burden while optimizing your MIPS score and maximizing your incentive potential.
Now that we are in the final MIPS 2021 reporting quarter, there is still an opportunity to finish out the year, not only avoiding a 9% penalty but to achieve an Exceptional Performer score (85 to 100). In this blog, we will expand on the opportunities.
There are three MIPS scoring plateaus:
Scores from 0 to 59.9
In the penalty area
Scores from 60.1 to 84.9
In the Budget Neutral area - The Incentives are paid from funds collected from providers that score 59.9 and below.
Scores from 85 to 100
Exceptional Performers – The incentives are a combination of the Budget Neutral incentive plus the Exceptional Performer funds. The Exceptional Performer bonuses are paid out of a $500 million budget the CMS distributed to providers scoring between 85 -100.
The Extreme and Uncontrollable Circumstances Exception (EUC)
In 2021, due to the option to opt out of MIPS by electing the Extreme and Uncontrollable Circumstances Exception (EUC), there will be fewer participants in the MIPS program for Performance Year 2021. This will result is two situations:
The funds in the Budget Neutral bucket will be greatly reduced
The number of providers in the Exceptional Performer group will be reduced
The above two scenarios can create a lower number of providers that are within the Exceptional Performer group. With a lower denominator, it will increase the percentage of the $500 million incentives that will be distributed to the providers in the Exceptional Performer group.
You can see a potential penalty/incentive that you would be eligible to receive if you place your information (NPI or Medicare Part B annual reimbursement) in our MIPS Calculator.
Darena Solutions is a recognized leader in providing MIPS consultation to eligible providers and groups to allow you to optimize your MIPS scoring to maximize your incentives. Darena Solution provides a one-stop approach from data acquisition, analysis to submission to CMS as a Qualified Registry.
There is still time for MIPS Eligible providers to act on the 2021 MIPS Performance Year and leverage multiple opportunities to participate. We can guide you through to not only avoid the 9% negative adjustment but to achieve the Exceptional Performer level. We also offer guidance on how to position yourself favorably for the 2022 MIPS Performance Year.
