On February 9, 2018, the Bipartisan Budget Act was signed into law. Under the Bipartisan Budget Act there were several elements that affect eligible clinicians (ECs) and groups in the Merit-based Incentive Payment System (MIPS) and will take effect in the 2018 performance year.
- Calculation of the low-volume threshold
- MIPS participation eligibility is determined through a calculation of annual Medicare Part B allowable charges. In 2018, ECs and groups must submit at least $90,000 annually and care for at least 200 Medicare beneficiaries annually to be eligible for a positive or negative payment adjustment based on performance. With the enactment of the Bipartisan Budget Act, Medicare Part B medications and services billed separately from the Physician Fee Schedule will no longer be included in the low-volume threshold calculation. For many specialists and small practice clinicians, this will likely result in their exclusion from the program for the 2018 performance year. If you are unsure of your eligibility, check the QPP participation look-up tool, which will be updated with the new calculation in March 2018.
- Cost performance category weight
- Under the Medicare Access and CHIP Reauthorization Act of 2015, the MIPS cost performance category was required to increase to 30% of the MIPS score by 2019. When the Quality Payment Program Year 2 Final Rule was released in November 2017, the cost performance category became 10% of the MIPS score for the 2018 performance score, with the plan to increase it to 30% for the 2019 performance year. The Bipartisan Budget Act allows the Centers for Medicare & Medicaid Services (CMS) and Medicare with provisions for the cost performance category to remain between 10% and 30% of the MIPS score for performance years two through five (2019-2021). With uncertainty looming about what the proposed cost measures may be and how the category will be scored, this shift will allow for a more gradual progression into full category implementation.
- Flexibility to determine the MIPS performance threshold
- MACRA also specified that by the 2019 MIPS performance year, the performance threshold needed to avoid a payment penalty was to be set at the average MIPS performance score. With the MIPS performance scores being entirely unknown for 2017 performance year, this increase would likely mean that a significant number of ECs and groups would not meet the threshold and would receive a negative payment adjustment of 7% or more, depending on program year. The Bipartisan Budget Act will enable CMS to have more flexibility in determining a gradually increasing performance threshold through 2021. This increased flexibility will provide ECs and groups with the ability to more effectively develop quality improvement and reporting strategies to meet the requirements of MIPS.
Additionally, while not directly related to MIPS, the Bipartisan Budget Act includes a reduction to the base Physician Fee Schedule payment update. MACRA included a provision to increase the base Physician Fee Schedule payment by 0.5% annually through 2019. Based on the changes made under the Bipartisan Budget Act, this annual increase will be reduced to 0.25% in 2019.
Still working on your 2017 MIPS data submission? The deadline for submission is March 31, 2018 to avoid a 4% negative payment adjustment on your 2019 Medicare Part B claims.
Need assistance? Contact the New England QIN-QIO for no-cost personalized assistance.