Home Forums Discussions MACRA/MIPS MIPS penalties... mostly (but not all) good news

This was news to me, and though others may be fully aware, I thought I would share this info.
Each year the penalties for not participating in MIPS have grown and the requirements for participation have become tougher. Each year's penalty is determined by your activities two years prior. So, for example, your MIPS activities and submissions in 2019 determined your penalties (or theoretically bonuses) for 2021. Your submissions in 2020 determine your penalties this year - in 2022 the penalty is 9% of Medicare payments, so it is a significant hit.
Each year many of us have made the calculation as to whether the work required to meet these increasingly stringent requirements was worth all the effort, or perhaps we should just take the penalty.

What I did not know is that due to Covid, Medicare has issued hardship exemptions for all practitioners for 2020 and 2021. This means even if you sent in nothing for MIPS in 2019, 2020, or 2021, you will suffer no penalty from your payments in 2021, 2022, and 2023. This is a big deal, and while I should have noticed it previously, I am just becoming aware of it now.

The downside for some of you is that all the energy, time and effort you spent on meeting the guidelines in 2019-21 and submitting your data for those years was unnecessary (unless by some chance you were among the lucky few who actually got a bonus payment).
In fact, you may actually be penalized FOR participating. That is because if you submit NO data, you automatically get a hardship exemption. But if you submitted data, the exemption is not automatic (you must request it); if you sent in data but did not meet the point requirements, you would then get a penalty.

Does this affect anyone here? Did those of you who participate in MIPS know about this waver?

There is a small industry of companies "helping providers meet the MIPS requirements" (for profit, of course). This can be a good thing. On the other hand, I think it is only fair that those companies publicize the waver so that people do not participate unnecessarily (and perhaps to their detriment). I am looking at you, AC/Harris, among others....

I did not know about the exemption for COVID, Thanks for sharing.

My experience with an exemption is not so great. SO in 2017 we were hit by Hurricane Harvey, devastating a large area of the south Texas region My front office girl was using my generator for over 2 weeks to power her home! We were supposed to be automatically exempt due to the Hurricane but.....I was not. My partner at the time was exempted but when I found they were penalizing me in 2019 they would not reverse the decision. I called a Medicare specialist (private party for direction) and was told there was nothing I could do. No appeal process is in place. He suggested I call my local federal representatives and see if they could help. I did not follow through contacting the reps as 2019 was a horrible year for me personally and not wonderful professionally so just took the licks and kept moving.

I hate that the government came up with a program where we are penalized if we don't jump through the hoops and it is so convoluted that we have to HIRE an outside company to keep them happy. Ridiculous how it is all based off of check box responses not actually how patients are doing or outcomes.

So this is a topic near and dear to my heart, as I have been working very closely with AC users on both Meaningful Use and MIPS for the past 11 years (MU stage 1 came out in 2011). A lot of you on this board have been to my in person seminars back in the day about MU and how to pass this with Amazing Charts. Ho here are my 2 cents on it all.

For the exclusions.. There are several exclusions that practices can apply for every year. Normally the 2 main ones are the Extreme and Uncontrollable Circumstances exemption and the Promoting Interoperability Exemption. The first can grant you an exemption for all of MIPS, the 2nd will exclude you from the PI category only. In most cases, a practice has to apply for these exemptions every year (easily done from www.qpp.cms.gov). The past couple years there has been some automatic exemptions, but I always stress to the clients I work with to apply anyway. This way it is on record that you applied for the exemption.

The COVID exemption was an example for last year. If you did not submit any data then you were granted an automatic exclusion under COVID. My one problem with this, is what happens if a practice get audited? Can you prove that your practice was impacted by COVID, and how? Expecially knowing that Medicare has access to your financials for that year. They know you were open, what type of office visits you had, and what was done. To me it just smells like a good trap (I have been through a lot of audits, maybe I am jaded).

Now, here is the good news. MIPS is actually EASIER than it has ever been. It is not as bad as MU was, and much more forgiving. There are 2 main areas that most Amazing Charts practices will need to focus on to get full credit for 2022, Quality and Improvement Activates. Improvement Activites are easy, those are just yes or no attestation questions that most people can do. There is a list of 100 activites, you need to fin 1 or 2 that you can say yes to. Do you have AC on the cloud? Great, you have 24/7 access to the medical record.. You are done. What about checking the state PDMP website for narcotics? Great.. Done.. they are that easy.

Quality is equally as easy, IF you have our new PopHealth interface. These are your day to day measures that you would be familiar with (things like tobacco screening, controlling high blood pressure, or A1c control, for example) Gone are the days where you have to jump through 1000 different hoops to get credit for a measure (Everyone remembers MU and all the teal buttons). Now, its as easy as adding some templates to the chart and going about your day. I have had a hand in designing all the workflows for these measures and my goal is to make them as easy as possible. I don't want you spending any more time than necessary on these items. in fact, once we have it set up, the provider will maybe spend 10-30 seconds completing the measure. Now there is a cost to PopHealth (not going to lie there), but its reasonable. Email me if you want more information.

The other 2 categories (PI and Cost) don't require any participation. The cost category is automatically calculated off of your superbills to Medicare, and the PI category (which includes eprescriging, patient portal, and direct messaging measures) has an exclusion what 99% of AC practices can claim an exclusion for (being a small practice).

Every practice I had worked with last year passed MIPS with flying colors, with most getting the exceptional bonus. The worst thing you can do is do nothing. Penalties are up to 9%. That is a big chunk off your Medicare payments. Like a lot of these companies, we do also offer a MIPS Success Service (for profit, again. being honest). I work with your practice on am quarterly basis, making sure you stay on track and can get the most our of the program. I also advise when to take exclusions, which are the best to claim, and make sure that each one is sumbitted successfully. I also help clients attest at the end of the year, and keep them updated on what is changing during the year. Is it an extra charge? Yes... But I think I am worth it. :-)

If anyone has any questions on the MIPS program, what we offer, or want to discuss their options to see if any of this is worth it for them, I would be happy to do a free, one time 1on1 consultation with anyone from this board. Just email me at mdabeck@harriscomputer.com and mention this post. We will set up some one on one time to review the MIPS program.

PS.. sorry for the long post.

Thanks for the post. Can't believe MIPS, meaningful use and all of the other names for this program has been around for 11 years. We used to jump through all of the hoops but recently haven't. Probably not since 2017 and the hurricane.

Don't apologize for the long post, it is informative and will likely take you up on your offer.........

Never heard of PopHealth Interface, not sure about the portal and how to set up without using UpDox

Interested in how much is charged for the interface and your time versus the 9% difference or "exceptional bonus".......guess the 1 time consultation could lok into this for me.

In typical governmental fashion the 9% penalty is spelled out and exact but the "bonus" can't be calculated until they know how much in penalties have been paid and then it is a linear depending on how many people qualify for the bonus.

That is mostly due to the program being budget neutral. As a taxpayer, I don't mind this so much. It does make it a bit harder to see what the bonus will actually be. Max bonus I have seen so far is + 1.87%.

One thing to keep in mind, the penalties, much like the bonus, work on a sliding scale. Unlike MU where if you missed one thing you failed for the whole program, MIPS works a little differently. Say the target to avoid a penalty is 70 points, and you got 60 points. You do not automatically get the 9% penalty (which is the max). You could get only a 1% penalty. So in that case, even if you are not "passing" it is still worth submitting what you did do to lessen the penalty as much as possible.

As for PopHealth. Its a new interface, and it is actually the first of its kind (with any EHR) to connect directly to CMS. We are able to pull your actual MIPS score year round from CMS, and we submit directly to them at the end of the year (no more downloading or printing a bunch of different files and manually punching in the numbers on the CMS site). Plus, as I said previously, the workflows for the measures are pretty easy. Just send me an email and I can set up a time to show you.

Mark,
First let me thank you both for your consistent helpful participation on this board, for your longstanding efforts to help AC users in many areas, and for your years long work to understand the "incentive programs" and to explain how we can use AC to leverage our participation in those programs.

I have long advocated that docs should look annually at the potential penalties as well as the estimated costs of participation, and to make a calculation as to whether participation makes sense or not. In some years the amount of work seemed trivial (once I understood exactly what was involved) and in some years there were essentially automatic exclusions that I could honestly claim to avoid penalties. As I look back, this has worked for me; I am satisfied that I earned a decent amount through the incentives in the early years, and avoided penalties in later years.

I will also say the incentives were significant in the early years, but when MIPS came into play, I found them to no longer be a major consideration. As noted above, the bonuses are/were not guaranteed, either in amount or because you meet some metric. As Mark points out... the maximum achieved is under 2%. Aiming for that never made sense to me. My goal was always to "stay at 0" and avoid a penalty.

After 2020, I decided that enough was enough, and the amount of work required was simply too onerous, and so I would take my lumps, beginning in 2022-2023.

It turns out that any efforts to participate to avoid a penalty in 2021, 2022, or 2023 were unnecessary. This is the main point I am posting about. It turns out whether we asked for it or not, nearly all of us got an exemption and avoided the penalty. With one unfortunate exception: If you did not send in data for the years in question, you automatically are exempt from a penalty. If you DID participate and send in data, you do not get the exemption and still can end up with a penalty. (Yes, you can conceivably get a bonus, but as above, that is pretty unlikely and trivial).
What this means, is that CMS in its wisdom, unintentionally undercut the efforts of those who participated (and Mark) despite everyone's good intentions.

Again... the reason I titled this post as "mostly good news" is that for most, the lack of penalties in these 3 years is good. Unfortunately for some of those who did the work and paid the money to participate, it is not.

Of course now it is 2022, and our activities this year determine penalty/bonus for 2024. Who knows what the rules will be for that year. Once again, each person needs to make the calculation of the risk/cost of participation... with the added caveat that the rules may change AGAIN, so it is hard to know.