CMS announces changes to MIPS Claims-based Quality Measures for 2020

Date: December 27, 2019

If you are considering reporting for 2020 under the Quality Payment Program (QPP) and are using MIPS to do so via Claims-based reporting, there are some important changes to be aware of.  Some claims-based measures have changed in important ways, and that has made significant impacts on which measures are available for practices and providers to choose from – and how you actually go about reporting them beginning January 1, 2020.

CMS released the Measure Specifications sheets for claims-based reporting recently.  To access them, see this link, then scroll down to the “Full Resource Library” and use the appropriate filters as follows “2020”, “MIPS”, “Quality”, and “Measure Specifications and Benchmarks”.  Click on the “2020 Medicare Part B Measure Specifications and Supporting Documents”.  There will be a ZIP file which you download (two folders, one of which is for Measures) and then open the individual Quality Measure Specification sheets as PDF files.

For 2020 Part B claims-based reporting, Measure 19 is no longer available; it’s titled “Diabetic Retinopathy: Communication with MD managing diabetes care”.  It can be used for other reporting methodology (eg, Registry or direct EHR), but not claims.  If you do happen to inadvertently report for this measure on 2020 claims, it will not count.

The other major change is in Measure 117 (Diabetes:  Eye Exam). The actual codes that you report on claims are different although the Quality actions taken are the same.  It remains as required “at least once per year” and the patient ages upon which you report are still 18-75.  Either Eye or E/M exams codes are applicable as before.  The 2019 codes are no longer valid and should not be used as of January 1, 2020.  The new 2020 Quality codes are:

  • G2102 Dilated Exam documented
  • G2103 7 Standard Field Photos taken
  • G2104 Eye Imaging validated to match 7 Standard [eg, wide or ultrawide angle photos]
  • 3072F No Evidence of Retinopathy
  • In the rare instance you have a patient in Hospice status or one who is in a Special Needs Plan or Long-term care (> 90 days) status, there are other new codes for those purposes; see the Part B claims Specification sheet for specifics.

We are happy to assist you with general claims issues and other QPP/MIPS topics, which include: proper code selection, chart reviews and payer action questions. Our new Practice Improvement Partnership (PIP) can assist with operations, practice optimization, and efficiency.  We provide training on these and other subjects. You can download our “App”, Corcoran 24/7 via one of the links below.

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