MIPS archive

Eligibility Criteria

Eligibility criteria remain the same for the 2021 performance year. Eligible clinicians or groups who meet all of the following three criteria during the MIPS determination period are required to participate:

• those who have allowed charges for covered professional services more than or equal to $90,000; and

• those who provide covered professional services to 200 or more Part B enrolled individuals; and

• those who provide 200 or more covered professional services to Part B-enrolled individuals .

Opt-in policy remains the same. It allows physicians or groups who meet one or two of the low-volume threshold criteria to opt-in to participate in MIPS and receive a final score and payment adjustment.

Payment Adjustment

The 2021 performance period payment adjustment (penalty or incentive) is 9% applied to reimbursements in 2023.

Minimum Threshold

Minimum points needed to avoid penalty: 60 points

• Up 15 points from 2020 (45 points)

Maximum Threshold

Minimum points needed for getting an incentive: 85 points

• No change from 2020

MIPS Category Breakdowns

Quality: 40% of MIPS score

• 5% decrease in category weight from 2020

• Data completeness remains at 70%

  • Small practices (15 providers or fewer) receive 3 points for not meeting data completeness

  • Large practices (16 providers or more) receive 0 points for not meeting data completeness

• Performance period: Jan. 1 – Dec. 31, 2021

• Submission methods: claims (for small practices), registry, QCDRs such as the Academy's DataDerm^TM, and EHRs

• 6 bonus points added to quality category for small practices (15 providers or fewer)

Improvement Activities: 15% of MIPS score

• No change in category weight from 2020

• Medium- and high-weighted activities available

• Group participation threshold remains the same as 2020 (50% of participation of eligible clinicians in group)

• Performance period: 90-day continuous performance period between Jan. 1 – Dec. 31, 2021

  • Participating clinicians do not have to perform activity at the same time

• Submission methods: CMS or QCDR

Promoting Interoperability: 25% of MIPS score

• No change in category weight from 2020

• 2015 CEHRT required (Certified EHR Technology)

• Performance period: continuous 90-days between Jan. 1 – Dec. 31, 2021

• Submission methods: registry, QCDRs, EHRs

• Increasing the Query of Prescription Drug Monitoring Program (PDMP) bonus measure under the e-Prescribing objective from 5 points to 10 points

• New Health Information Exchange (HIE) optional measure: HIE Bi-Directional Exchange

• Hardship exemption available in late 2021

Cost: 20% of MIPS score

• 5% increase from 2020 (15%)

• No action required by eligible clinician

Scoring

The scoring for each category remains the same as 2020 methodology.

Reporting Type

Group vs individual reporting available

• Individual: Under an NPI number and TIN where they reassign benefits; report via claims, registry, or EHR

• Group: Two or more clinicians (by NPIs) who have reassigned their billing rights to a single TIN; report via claims, registry, or EHR

Small Practice Accommodations

Accommodations for small practices include:

• 3 points for measures that do not meet data completeness of 70%

• Claims reporting available

• 6 bonus points added to numerator of quality category

• EHR hardship application available

Additional AAD Resources