CMS Releases 2019 MIPS Proposed Rule Changes

Are you participating in MIPS? If so, you should know that there are going to be some changes to the program in 2019. CMS has been collecting stakeholder feedback about MIPS over the past couple years, which they’ve used to continue to develop the program. While MIPS will look very familiar next year, there are a few possible changes that could have a big impact on you and your organization. Here are some of the highlights from the new proposed rule:

New clinician types

CMS proposed to add the following clinician types to MIPS:

  • Physical therapist
  • Occupational therapist
  • Clinical social worker
  • Clinical psychologist

Clinician types that were eligible to participate in 2018 remain in the program for the 2019 performance year.

Some groups and clinicians could choose to opt-in

Clinicians and groups would have the choice to opt-in to MIPS if they met or exceeded one or two, but not all three, of the low-volume threshold criterion.

Expanded low-volume threshold

The low-volume threshold would have an additional category in 2019, so that groups and clinicians would qualify to be excluded if from MIPS if they met any of these three criterion:

  • Have less than or equal to $90k in Part B allowed charges for covered professional services
  • Provide care to 200 or less beneficiaries
  • Provide 200 or less covered professional services under the Physician Fee Schedule (PFS)
More flexible submission mechanisms

Individual clinicians would be able to submit a single measure via multiple collection types, such as MIPS CQM, eCQM, QCDR measures and Medicare Part B claims measures. They would be scored on the data submission with the greatest number of measure achievement points.

Additionally, groups and virtual groups would be able to use multiple collection types.

Unchanged performance period

In the proposed rule, the MIPS performance period would remain the same in 2019 as in 2018:

  • Quality Category: 12 months
  • Cost Category: 12 months
  • Improvement Activities: 90 days
  • Promoting Interoperability: 90 days

Those are some key takeaways for what to expect heading into year 3. A full breakdown of each proposed MIPS changes can be found in the table below.

CMS is currently accepting feedback on the proposed rule at regulations.gov. The 60-day comment period will end on September 10, 2018. It is expected CMS will release the final rule in late fall. Check the SurveyVitals blog for updates or subscribe to our MIPS list here.

For more information about how SurveyVitals can help you complete your MIPS requirements, email us at info@surveyvitals.com or sign up for a quick overview. Also feel free to chat with us using the blue chat icon in the bottom-right corner of your screen at anytime.

Policy Area Current Year 2 (Final Rule CY 2018) Year 3 (Proposed Rule CY 2019)
MIPS Eligibility Eligible clinician types include:
  • Physician
  • Physician assistant
  • Nurse practitioner
  • Clinical Nurse specialist
  • Certified registered nurse anesthetist
  • A group that includes such professionals (required by statute)
Eligible clinician types include:

Eligible clinician types remain the same as Year 2 with the following additions:

  • Physical therapist
  • Occupational therapist
  • Clinical social worker
  • Clinical psychologist
Low-Volume Threshold (LVT)
  • To be excluded from MIPS, clinicians and groups must meet one of the following two criterion: have ≤ $90K in Part B allowed charges for covered professional services OR provide care to ≤ 200 beneficiaries.
  • The low-volume threshold would include a third criterion for determining MIPS eligibility
  • To be excluded from MIPS, clinicians or groups would need to meet one of the following three criterion: have ≤ $90K in Part B allowed charges for covered professional services, provide care to ≤ 200 beneficiaries, OR provide ≤ 200 covered professional services under the Physician Fee Schedule (PFS)
  • Opt-in
  • Not Applicable
  • Starting in Year 3, clinicians or groups would be able to opt-in to MIPS if they meet or exceed one or two, but not all, of the low-volume threshold criterion
  • MIPS Determination Period Low Volume Threshold Determination Period:
    • First 12-month segment: Sept. 1, 2016 to Aug. 31, 2017 (including a 30-day claims run out)
    • Second 12-month segment: Sept. 1, 2017 to Aug. 31, 2018 (including a 30-day claims run out)
    • Note: If a clinician or group is identified as not exceeding the LVT during this time, they will be excluded regardless of the results of the second 12-month analysis
    Hospital-Based MIPS eligible clinician:
    • MIPS eligible clinician furnishing 75% or more of covered professional services in POS 19, POS 21, POS 22, or POS 23 based on claims for a period prior to the performance period
      • Claims will be used from September 1 of the calendar year, 2 years preceding the performance period through August 31 of the calendar year preceding the performance period; if not feasible, claims from a 12-month period close to this period will be used
    ASC-Based MIPS eligible clinician:
    • MIPS eligible clinician furnishing 75% or more of covered professional services in POS 24 based on claims for a period prior to the performance period
      • Claims will be used from September 1 of the calendar year 2 years preceding the performance period through August 31 of the calendar year preceding the performance period; if not feasible, claims from a 12-month period close to this period will be used
    Now referred to as MIPS Determination Period:
    • Created a streamlined and consistent “MIPS determination period” for different categories of clinicians, which will be used to determine the low-volume threshold and the following special statuses: non-patient facing, small practice, hospital-based, and ASC-based
      • First 12-month segment: Oct. 1, 2017 to Sept. 30, 2018 (including a 30-day claims run out)
      • Second 12-month segment: Oct. 1, 2018 to Sept. 30, 2019 (does not include a 30-day claims run out)
    • Hospital-based MIPS eligible clinician determinations would be based on claims from the MIPS determination period
    • ASC-based MIPS eligible clinician determinations would be based on claims from the MIPS determination period
    Virtual Groups In general, group policies apply to virtual groups, except:
    • A virtual group will be considered a small practice if it contains 15 or fewer clinicians
    • A virtual group will be designated as rural or HPSA practice if more that 75% of the NPIs billing under the virtual group’s TINs are designated in a ZIP code as a rural area or HPSA
    • A virtual group will be considered non-patient facing if more than 75% of the NPIs billing under the virtual group’s TINs meet the definition of a non-patient facing individual MIPS eligible clinician during the non-patient facing determination period
    Virtual group election
    • Must be made by December 31 of the calendar year preceding the applicable performance period, and cannot be changed during the performance period
    • The election process can be broken into two stages: Stage 1 (which is optional) pertains to virtual group eligibility determinations, and stage 2 pertains to virtual group formation

    To meet the eligibility requirements, each member of a virtual group must establish a formal written agreement prior to an election

    • A designated virtual group representative must e-mail a virtual group election to MIPS_VirtualGroups@cms.hh s.gov by December 31 of the calendar year prior to the start of the applicable performance period
    Virtual group policies remain the same as Year 2, with the following change:
    • Beginning with 2019 the virtual group eligibility determination period aligns with the first segment of data analysis under the MIPS eligibility determination period.
      • For example: Oct. 1, 2017 to Sept. 30, 2018 (including a 30-day claims run out)
    Virtual Group election is the same as Year 2, with the following change:
    • As part of the virtual group eligibility determination period, TINs would be able to inquire about their TIN size prior to making an election during a 5- month timeframe, which would begin on August 1 and end on December 31 of a calendar year prior to the applicable performance period. TIN size inquiries would be made through the Quality Payment Program Service Center. Technical assistance resources already available to stakeholders would continue to be available

    The requirement for virtual groups to have a formal written agreement between each member of a virtual group remains the same for Year 3

    • For 2019, a designated virtual group representative must e-mail a virtual group election to MIPS_VirtualGroups@cms.hhs.g ov by December 31 of the calendar year prior to the start of the applicable performance period
    MIPS Performance Period Minimum Performance Period for each Performance Category:
    • Quality: 12-months
    • Cost: 12-months
    • Improvement Activities: 90-days
    • Promoting Interoperability: 90-days
    Minimum Performance Period for each Performance Category:
    • Same performance periods as in Year 2
    Quality Performance Category Weight to final score:
    • 50% in Year 2
    • The Quality performance category may be reweighted
      • If a score cannot be calculated due to no applicable and available measures
      • Due to extreme and uncontrollable circumstances

    For individual eligible clinicians, one submission mechanism must be selected:

    • Claims
    • QCDR
    • Qualified registry
    • EHR
    Groups and Virtual Groups must use one submission mechanism:
    • QCDR
    • Qualified registry
    • EHR
    • CMS Web Interface (groups of 25+)
    • CMS-Approved Survey Vendor for CAHPS for MIPS
    Data Completeness Requirements
    • Claims: 60% of Medicare Part B patients for the performance period
    • QCDR/Registry/EHR: 60% of clinician’s or group’s patients across all payers for the performance period
    • CMS Web Interface: Sampling requirements for Medicare Part B patients
    • CAHPS for MIPS Survey: Sampling requirements for Medicare part B patients
    Topped-Out Measures:

    Definition: if measure performance is so high and unvarying that meaningful distinctions and improvement in performance can no longer be made. QCDR measures would not go through the comment and rulemaking process to remove topped out measures. Policies include:

    • Finalized 4-year lifecycle for identification and removal of topped out measures
    • Scoring cap of 7 points for topped out measures
    • Policies to identify, remove and cap scoring for topped out measures do not apply to CMS Web Interface measures
    • Policy does not apply to CAHPS for MIPS Summary Survey Measures (SSMs)
    • 6 measures identified for scoring cap for topped out measures
    Measures Impacted by Clinical Guideline Changes:
    • No requirements
    Bonus Points: High-Priority Measures (after first required measures)
    • 2 points for outcome, patient experience
    • 1 point for other high priority measures which need to meet data completeness, case minimum, and have performance greater than 0
    • Capped bonus points at 10% of the denominator of total Quality performance category
    Bonus Points:End-to-End Electronic Reporting:
    • 1 point for each measure submitted using electronic end-to-end
    • Capped at 10% of the denominator of total Quality performance category points
    Improvement Scoring – Full Participation:
    • Eligible clinicians must fully participate (i.e., submit all required measures and have met data completeness criteria, and for performance year
    • The quality improvement percent score is 0 if the eligible clinician did not fully participate in the quality category for the current performance period
    • If the eligible clinician has a previous year Quality performance category score less than or equal to 30%, we would compare 2018 performance to an assumed 2017 Quality category score of 30%
    Weight to final score
    • 45% in Year 3
    • Maintain the same reweighting criteria for the Quality Performance category

    In Year 3, individual eligible clinicians would be able to submit a single measure via multiple collection types (e.g. MIPS CQM, eCQM, QCDR measures and Medicare Part B claims measures) and be scored on the data submission with the greatest number of measure achievement points

    Groups and Virtual Groups would be able to use multiple collection types.
    • The Quality performance category would be scored if groups submit data using multiple collection types (e.g. MIPS CQM, eCQM, QCDR measures, and Medicare Part B claims measures)
    • CMS Web Interface cannot be scored with other collection types other than the CMS approved survey vendor measure and/or administrative claims measures
    Data Completeness Requirements:
    • The same data completeness requirements as Year 2, with the following change:
    • For groups registered to report the CAHPS for MIPS survey, there is an additional policy. If the sample size was not sufficient, the total available measure achievement points (the denominator) would be reduced by 10 points and the measure would receive zero points
    Topped-Out Measures:
    • The definition and lifecycle for topped out measures remain the same for Year 3, although additional factors may affect the time a topped-out measure remains as such
    Measures Impacted by Clinical Guideline Changes:
    • In response to clinical guideline or other changes, impacted measures will be given a score of 0 and the Quality performance category denominator would be reduced by 10. If this situation occurs the clinician would be required to submit data for one less measure (i.e. 5 measures instead of 6)
    Bonus Points: High-Priority Measures (after first required measure)
    • Same as Year 2, with the following change:
    • Discontinue high priority measure bonus points for CMS Web Interface Reporters
    Bonus Points: End-to-End Electronic Reporting:
    • Same as Year 2.
    Improvement Scoring – Full Participation:
    • Same as Year 2
    Cost Performance Category Weight to final score:
    • 10% in Year 2
    Measures:
    • Two measures: Total Per Capita Cost and Medicare Spending Per Beneficiary (MSPB)
    • Derived from Medicare claims
    • Reliability threshold of 0.4
    • Case minimum of 20 for total per capita cost and 35 for MSPB
    Measure Attribution:
    • Plurality of primary care services rendered by the clinician to determine attribution for the total per capita cost measure
    • Plurality of Part B services billed during the index admission to determine attribution for the MSPB measure
    • Added two CPT codes (99487 and 99489 describing complex chronic care management) to list of primary care services used to determine attribution under the total per capita cost measure
    Scoring Improvement:
    • Improvement scoring added to the Cost performance category scoring methodology with a maximum cost improvement score of 1 percent;
    • However, the Bipartisan Budget Act of 2018 delayed consideration of improvement in the Cost performance category until the 2024 payment year (based on the 2022 performance year). As a result, there will be no improvement scoring in Year 2 MIPS payment year.
    Calculating the Cost Score:
    • Cost Achievement Points/Available = Cost Performance Category Percent Score
    • The percent score cannot not exceed 100%
    • The Bipartisan Budget Act of 2018 delayed consideration of improvement in cost until the 2024 MIPS payment year (based on the 2022 performance year)
    • We will not calculate a Cost performance category score if the eligible clinician is not attributed any Cost measures, because of case minimum requirements or the lack of a benchmark
    Weight to final score:
    • 15% in Year 3
    Measures:

    The Total Per Capita Cost and MSPB measures will be the same as in Year 2, with the following changes:

    • 8 episode-based measures will be added to the list of Cost measures
    • Case minimum of 10 for procedural episodes and 20 for acute inpatient medical condition episodes
    Measure Attribution

    Same as Year 2 with the following changes:

    • For procedural episodes, we will attribute episodes to each MIPS eligible clinician who renders a trigger service as identified by HCPCS/CPT procedure codes
    • For acute inpatient medical condition episodes, we will attribute episodes to each MIPS eligible clinician who bills inpatient evaluation and management (E&M) claim lines during a trigger inpatient hospitalization under a TIN that renders at least 30 percent of the inpatient E&M claim lines in that hospitalization
    Scoring Improvement
    • Cost performance category percent score will not take into account improvement until the 2024 MIPS payment year
    Calculating the Cost Score:
    • Same as Year 2
    Facility-Based Quality and Cost Performance Categories Measurement:
    • Not Applicable
    Applicability – Individual:
    • Not Applicable
    Applicability – Group:
    • Not Applicable
    Attribution
    • Not Applicable
    Election
    • Not Applicable
    Benchmarks
    • Not Applicable
    Assigning MIPS Category Scores:
    • Not Applicable
    Scoring Improvement:
    • Not Applicable
    Scoring – Special Rules:
    • Not Applicable
    Measurement:
    • For facility-based scoring, the measure set for the fiscal year Hospital Value-Based Purchasing (VBP) program that begins during the applicable MIPS performance period will be used for facility-based clinicians
    Applicability – Individual:
    • MIPS eligible clinician furnishes 75 percent or more of their covered professional services in inpatient hospital, on-campus outpatient hospital, as identified by POS code 22, or an emergency room, based on claims for a period prior to the performance period
    • Clinician must have at least a single service billed with the POS code used for the inpatient hospital or emergency room
    Applicability – Group:
    • Facility-based group is one in which 75 percent or more of the MIPS eligible clinician NPIs billing under the group’s TIN are eligible for facility-based measurement as individuals
    Attribution:
    • A facility-based clinician is attributed to the hospital at which they provide services to the most Medicare patients
    • A facility-based group is attributed to the hospital at which a plurality of its facility-based clinicians are attributed
    • If unable to identify a facility with a VBP score to attribute a clinician’s performance, that clinician is not eligible for facility-based measurement and will have to participate in MIPS via other methods
    Election:
    • Automatically apply facility-based measurement to MIPS eligible clinicians and groups who are eligible for facility-based measurement and who would benefit by having a higher combined Quality and Cost score
    • No submission requirements for individual clinicians in facility-based measurement but a group must submit data in the Improvement Activities or Promoting Interoperability performance categories in order to be measured as a group under facility-based measurement
    Benchmarks:
    • Benchmarks for facility-based measurement are those that are adopted under the Hospital VBP program of the facility for the year specified
    Assigning MIPS Category Scores:
    • Both the Quality performance category score and Cost performance category score for facility-based measurement are reached by determining the percentile performance of the facility determined in the VBP program for the specified year and awarding a score associated with that same percentile performance in the MIPS Quality and Cost performance category scores for those clinicians who are not scored using facility-based measurement
    Scoring Improvement:
    • Given that improvement is already captured in the distribution of the MIPS performance scores that is used to translate a Hospital VBP Program Total Performance Score into a MIPS Quality performance category score, there is no additional improvement scoring for facility-based measurement for either the Quality or Cost performance category
    Scoring – Special Rules:
    • Some hospitals do not receive a Total Performance Score in a given year in the Hospital VBP Program, whether due to insufficient quality measure data, failure to meet requirements under the Hospital IQR Program, or other reasons. In these cases, we would be unable to calculate a facility-based score based on the hospital’s performance, and facility-based clinicians would be required to participate in MIPS via another method
    Improvement Activities Performance Category Weight to final score:
    • 15% in Year 2
    Improvement Activities Inventory
    • Initial inventory established based on research, environmental scan and priorities
    • In Year 2, the Annual Call for submitting Improvement Activities, was established
    Improvement Activities Inventory Submission Timeline
    • Submissions at any time during the performance period to create an Improvement Activities Under Review (IAUR) list; submissions received by March 1st will be considered for inclusion in the following calendar year
    CMS Study on Burdens
    • Study purpose, participation credit and requirements and study procedures updated from Year 1 establishment
    Scoring: PI Bonus
    • Certain improvement activities will qualify for a bonus under the PI performance category
    Weight to final score
    • 15% in Year 3
    Improvement Activities Inventory
    • In Year 3, the timeframe for the Annual Call for Activities and the improvement activities inventory would be modified
    • Modifications include the addition of one new criteria in this category, “Include a public health emergency as determined by the Secretary,” and the removal of, “Activities that may be considered for a Promoting Interoperability bonus”
    • Adding 6 new Improvement Activities
    • Modification of 5 existing Improvement Activities
    • Removal of 1 existing Improvement Activity
    Improvement Activities Inventory Submission Timeline
    • Improvement activity nominations received in Year 3 will be reviewed and considered for possible implementation in Year 5 of the program
    • The submission timeframe/due dates for nominations would be from February 1st through June 30th, providing approximately 4 additional months to submit nominations
    CMS Study on Burdens
    • The CMS study title would be changed to, “CMS Study on Factors Associated with Reporting Quality Measures”
      • The sample size would be increased to 200 MIPS eligible clinicians with focus group requirements for only a subset of study participants
    • We are also proposing to limit the focus group requirement to a subset of the 200 participants, and require that at least one of the minimum of three required measures be either an outcome or a high priority measure
    Scoring: PI Bonus
    • In Year 3, the Promoting Interoperability bonus will be removed
    Promoting Interoperability (PI) Performance Category Weight to final score:
    • 25% in Year 2
    Note: Performance category name changed to Promoting Interoperability. Reweighting:
    • Reasons to reweight the PI category to 0% include:
    • Nurse practitioner, physician assistant, clinical nurse specialist, or certified registered nurse anesthetist
    • Significant hardship (e.g. lack of internet, extreme and uncontrollable circumstances, small practice)
    • 50% or more of patient encounters occurred in practice locations where no control over the availability of CEHRT
    • Non-patient facing
    • Hospital-based
    • ASC-based
    • Automatic reweighting for extreme and uncontrollable circumstances
    • Even if the category could be reweighted
    • MIPS eligible clinicians using decertified EHR Technology, exception available for no more than 5 years
    • For any of the above reasons, if a MIPS eligible clinician reports PI (formerly ACI) measures and objectives, they will be scored like other MIPS eligible clinicians and the PI performance category will not be reweighted to 0%
    Certification Requirements:
    • Eligible clinicians may use either the 2014 or 2015 Edition CEHRT or a combination of the two; one-time bonus of 10 percentage points in if using only 2015 Edition CEHRT
    Scoring:
    • Performance category score is comprised of the base, performance, and bonus score
    • Clinicians must complete the base score requirements in order to receive a score in the category
    Objectives and Measures
    • Two measure set options for reporting based on the clinician’s CEHRT edition (either 2014 or 2015).
    Weight to final score:
    • 25% in Year 3
    Reweighting
    • Reweighting of the Promoting Interoperability performance category remains the same as Year 2 and extends to additional clinician types (physical therapists, occupational therapists, clinical social workers, and clinical psychologists)
    Certification Requirements
    • Eligible clinicians must use 2015 Edition CEHRT in Year 3
    Scoring:
    • Eliminating base, performance, and bonus scores
    • Proposing a new scoring methodology
    • Performance-based scoring at the individual measure-level. Each measure would be scored based on the MIPS eligible clinician’s performance for that measure based on the submission of a numerator or denominator, or a “yes or no” submission, where applicable
    • The scores for each of the individual measures would be added together to calculate the score of up to 100 possible points. If exclusions are claimed the points for measures will be reallocated to other measures
    Objectives and Measures
    • One objectives and measure set based on the 2015 Edition CEHRT
    • Four objectives: e-Prescribing, Health Information Exchange, Provider to Patient Exchange, and Public Health and Clinical Data Exchange
    • Clinicians are required to report certain measures from each of the four objectives, unless an exclusion is claimed
    • Proposing to add two new measures to the e-Prescribing objective: Query of Prescription Drug Monitoring Program (PDMP) and Verify Opioid Treatment Agreement
    Final Score General Performance Category Weights in Year 2:
    • Quality: 50%
    • Cost: 10%
    • PI: 25%
    • IA: 15%

    If a MIPS eligible clinician is scored on fewer than two performance categories, a final score equal to the performance threshold will be assigned and the MIPS eligible clinician will receive an adjustment of 0%

    Small Practice Bonus
    • A bonus of 5 points is added to the final score for MIPS eligible clinicians, groups, virtual groups and APM Entities that meet the definition of small practice and submit data on at least one performance category in the 2018 performance period
    General Performance Category Weights in Year 3
    • Quality: 45%
    • Cost: 15%
    • PI: 25%
    • IA: 15%

    If a MIPS eligible clinician is scored on fewer than two performance categories, a final score equal to the performance threshold will be assigned and the MIPS eligible clinician will receive a payment adjustment of 0%

    Small Practice Bonus:
    • The small practice bonus will now be added to the Quality performance category, rather than in the MIPS final score calculation
    • Add 3 points in the numerator of the Quality performance category for MIPS eligible clinicians in small practices who submit data on at least 1 quality measure
    MIPS Payment Adjustments Application of Payment Adjustment to Medicare Paid Amount:
    • Finalized that for each MIPS payment year, the MIPS payment adjustment factor, and if applicable, the additional MIPS payment adjustment factor, are applied to Medicare Part B payments for items and services furnished by the MIPS eligible clinician during the year
    • However, the Balanced Budget Act of 2018 changed this so that the MIPS adjustment factors will apply to ‘covered professional services’ under the physician fee schedule beginning with the 2019 payment year
    • Finalized application of the payment adjustment to the Medicare paid amount
    Final Score/2020 payment adjustment
    • For individual eligible clinicians, we will use the final score associated with the TIN/NPI used during the performance period
    • For groups submitting data using the TIN identifier, we will apply the group final score to all the TIN/NPI combinations that bill under the TIN during the performance period
    • For eligible clinicians in a MIPS APM, we will assign the APM Entity group’s final score to all APM Entity Participant National Provider Identifiers associated with the APM Entity
    • For eligible clinicians that participate in APMs for which the APM scoring standard does not apply, we will determine a final score using either the individual or group data submissions
    • If a MIPS eligible clinician is not in an APM Entity and is in a virtual group, the MIPS eligible clinician would receive the virtual group final score over any other final score
    Application of Payment Adjustment to Medicare Paid Amount
    • Same as Year 2
    Final Score/2021 payment adjustment:
    • Remains the same as Year 2, with one change. MIPS eligible clinicians in a group practice who qualify for a group final score will have a modified determination period to include:
      • 15-month window that starts with the second 12-month determination period (October 1 prior to the MIPS performance period through September of the current MIPS performance period)
    • Proposed policy to assign a weight of 0% to each of the four performance categories and a final score equal to the performance threshold when:
      • MIPS eligible clinician joins an existing practice (TIN) in the final three months of the performance period year and the practice is not participating in MIPS as a group
      • MIPS eligible clinician joins a practice that is a newly formed TIN in the final three months of the performance period year
    Performance Threshold / Payment Adjustment
    • Performance Threshold is set at 15 points
    • Additional performance threshold set at 70 points for exceptional performance
    • MIPS eligible clinicians receive a payment adjustment and, if applicable, an additional payment adjustment, determined by comparing final score to performance threshold and additional performance threshold
    • A final score at or above the performance threshold receive a zero or positive payment adjustment and a score below the performance threshold receive a negative adjustment
    • As required by statute, the maximum negative payment adjustment is -5 percent positive payment adjustments can be up to 5% (but they are multiplied by a scaling factor to achieve budget neutrality)
    • The additional payment adjustments for exceptional performance starts at 0.5% and goes up to 10% x scaling factor not to exceed 1
    • Performance Threshold is set at 30 points
    • Additional performance threshold set at 80 points for exceptional performance
    • As required by statute, the maximum negative payment adjustment is -7 percent. Positive payment adjustments can be up to 7% (but they are multiplied by a scaling factor to achieve budget neutrality)
    • The additional payment adjustment for exceptional performance shall be applied in the same way as in 2018 for scores at or above the additional performance threshold

    *The contents of this table were originally published by CMS in the Proposed Rule for the Quality Payment Program Year 3.

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    August 27th, 2018 Categories: featured, MIPS

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