CMS Publishes 2020 Payment Adjustments related to 2018 MIPS/QPP Performance

Date: January 19, 2020

CMS recently made available the MIPS payment adjustment information for 2020.  Practices can check their results by logging in to the QPP.CMS.GOV webpage.  It appears from information received by our clients that the maximum bonus in 2020 for a perfect score is 1.68%.  That means that practices who scored a perfect 100% on 2018 MIPS will receive that adjustment on all individual Part B services delivered in 2020.  This 1.68% number reflects the sum of the basic MIPS positive payment adjustment (bonus) as well as the non-budget-neutral “exceptional performer” bonus.

Do not forget that the all QPP/MIPS payment adjustments are reflected in your EOBs in an unusual way.  Be sure to “harvest the positive adjustments” and place them in a non-patient account; leaving them in the patient account as a credit will mean giving them away over the course of the year as future visits occur.  Most practice management systems can do this correctly but do check.  We can help with this if there are questions.

The CMS Administrator, Seema Verma, noted in a post she authored for the CMS Blog on January 6, 2020, the following facts about 2018 MIPS overall performance:

  • 98 percent of clinicians avoided a negative payment adjustment, compared to 95 percent from last year. From a scoring perspective, the overall national mean (or average) and median scores increased from 2017.
  • Clinicians who specifically participated in MIPS through an APM had a mean score of 98.77 and a median score of 100.
  • 97 percent of eligible clinicians in rural practices will receive a positive payment adjustment, compared to 93 percent in 2017.
  • For small practices, 84 percent of eligible clinicians received a positive payment adjustment, an increase from 74 percent in 2017.

While the CMS Blog post is very upbeat, it also reflects the rationale for why these 2020 positive payment adjustments are lower for perfect scores than the 2019 payments (too many people were NOT penalized at all).  While we do not have much data at this time for other scoring levels, it is likely the trend to lower overall for equivalent scores is true.

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

Recent News

CMS Extends Deadline for MIPS 2023 Data Submission

CMS has extended the data submission period for the Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2023 performance year of the ...

Congress Passed bill for MPFS

The recent passing of a partial government funding bill by Congress on March 8 is important to Medicare beneficiaries. This bill includes policies aimed at addressing ...

Change to Processing for Telehealth Services Billed with POS 10

In calendar year (CY) 2024, the Centers for Medicare & Medicaid Services (CMS) issued a change to processing for telehealth services billed with POS 10. ...

Diabetes Cost Measure Misattributed to Ophthalmologists

The American Society of Cataract and Refractive Surgery (ASCRS), the American Society of Retina Specialists (ASRS) and the American Academy of Ophthalmology (AAO), met recently ...

Review Your 2022 MIPS Performance Feedback and Final Scores

The Centers for Medicare & Medicaid Services (CMS) has released the Merit-Based Incentive Payment System (MIPS) performance feedback and final scores for the 2022 performance ...

JZ Modifier Required July 1, 2023

The much-anticipated mandatory reporting of the JZ modifier for Part B Medicare begins July 1, 2023.  The new Medicare policy can be found here.  The ...

Cigna Hits the Brakes on Their New Modifier 25 Policy

Following fierce opposition from the physician community, the insurer Cigna announced today a delay in implementing a policy (PDF) that would have required submitting medical ...

Medical Consulting Group and Corcoran Consulting Group Announce Merger

Springfield, MO, April 27th, 2023. Medical Consulting Group (MCG), a provider of consulting services to ophthalmic practices and companies, and Corcoran Consulting Group (CCG), a ...

IHEEZO Gel gains Medicare Pass-Through

On March 13, 2023, Harrow® announced that the Centers for Medicare & Medicaid Services (CMS) has approved transitional pass-through reimbursement status for chloroprocaine hydrochloride ophthalmic ...

Cigna Change Modifier 25 Policy

As a result of a recent review, Cigna has announced it will require the submission of office notes with claims submitted for evaluation and management ...

Congress makes positive adjustments that affect ophthalmologists

In this Healio Video Perspective from Hawaiian Eye 2023, Kevin J. Corcoran, COE, CPC, CPMA, FNAO, discusses ophthalmic economic and regulatory updates for the year. ...

HHS Extends Covid-19 PHE

On Thursday, October 13, the U.S. Department of Health & Human Services (HHS) Secretary Xavier Becerra extended the nation's COVID-19 PHE for an additional 90 ...

Noridian Changes to Goniotomy LCD

Noridian has made changes to their Goniotomy coverage policy effective October 1st, 2022. It states: “Since there is no specific CPT® code for goniopuncture or ...

2021 MIPS Performance Feedback, 2021 MIPS Final Score, and 2023 MIPS Payment Adjustment Information

The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) performance feedback and final scores for the 2021 performance year, ...

Telehealth Place of Service Update

With a recent change to telehealth billing, billers need to be aware of an additional Place of Service code. What changed? Effective January 1, 2022, ...

Extension of Telehealth Flexibility

Last week, the U.S. House of Representatives approved legislation to further extend the Medicare telehealth flexibilities first instituted in response to the COVID-19 pandemic. If ...

AETNA No Longer Requiring Prior Authorization for Cataract Surgery

The American Society of Cataract and Refractive Surgery (ASCRS) and American Academy of Ophthalmology (AAO) have spearheaded a year-long effort to remove the policy that ...

2021 MIPS Final Score Preview Now Available

The Centers for Medicare & Medicaid Services (CMS) has opened the Final Score Preview period for the Merit-based Incentive Payment System (MIPS).  You can now ...

Guidance for Coding Goniotomy

Summary:   Two new ophthalmic surgical products have attracted interest from surgeons:  Streamline Viscoelastic Injector® (New World Medical) and IACCESS™ trabecular trephine (Glaukos).  In both cases, ...

CIGNA Changes Their Modifier 25 Policy

As a result of a recent review, CIGNA will require the submission of office notes with all claims submitted with evaluation and management (E/M) CPT ...

CMS Reweights Scoring for Cost Category for Groups in 2021 Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) announced on Monday, April 25th, that ALL eligible MIPS providers will automatically receive re-weighting of the Cost ...

IACCESS™ Trabecular Trephine – How to Code?

Summary:   Glaukos’ new product, the IACCESS™ trabecular trephine, raises interesting coding questions.  Standalone procedures should be reported on a claim for reimbursement as unlisted procedure, ...

Streamline® Viscoelastic Injector – How to Code?

Summary:   New World Medical’s new product, the Streamline® Viscoelastic Injector, raises interesting coding questions.  Standalone procedures with it should be reported on a claim for ...

HHS Extends the Public Health Emergency Waivers

On April 12, 2022, Secretary of Health and Human Services Xavier Becerra again renewed the public health emergency declaration that was initiated at the end ...