MIPS clinicians should review both the Individual and Group final scores for the MIPS 2020 performance year, even if you have already reviewed the report.
Reviewing your final scores is very important because clinicians who were individually non-eligible, but were eligible for Group-level submission for 2020, are being automatically scored for any Group-level Medicare Part B claims submissions. This could result in a negative payment adjustment up to 9% for these clinicians.
If you only submitted individually for your eligible clinicians, please make sure to review your Group-level score as well, so you can determine if any of your non-eligible individual clinicians received a final score and payment adjustment.
For the 2020 performance year, CMS automatically calculated a score for the Quality performance category at both the individual and group level. Those exempt providers were automatically scored because there was a claims submission which is at the-group level and the individual level as well. Additionally, the automatic extreme and uncontrollable circumstances policy applies only at the individual level for individually *eligible* clinicians, and does not cover the group nor those who are exempt individually. Because these NPIs were exempt individually, and eligible at the group level, and claims data was received at the group level, per policy they are receiving the appropriate group score and group payment adjustment.
If any of your clinicians received a score based on a Quality category claims submission, in which no other performance category data was submitted and received a negative payment adjustment, then it is urgent you complete a Targeted Review and submit before the 8 PM ET, October 1, 2021 deadline. In order to review your your feedback or request a targeted review, sign in HERE.
Questions? Contact your advisor or the experts at Kentucky REC. We’re here to help: 859-323-3090.