What Happens When I Choose Not to Report Data for MIPS 2021?

The MIPS 2021 reporting period has started. And here begins the struggle for physicians to report their data. There is a lot on the line, for instance, physicians’ reputation, payment adjustments, and bonuses.

But, what about the physicians, who choose to not report data. Simply, they will miss out on many things.

Every year, MIPS eligible clinicians struggle to comply with the data submission criteria. The amount of data that they have to go through to compile relevant files is huge. Most of them thus, reply on CMS recognized MIPS Qualified Registry to make sure their data is accurate and documented as per the high standards.

What Can Go Wrong When Physicians Do Not Report MIPS 2021 Data?

The thing is MIPS 2021 reporting is a chance to go bigger with incentives as long as physicians report for it. In an otherwise situation, the following cases can occur.

Physicians are Excused from 9% of MIPS Penalty

The good news is this year, CMS will not put any penalty for any physician if they choose to not report in 2021. However, it implies that they will have any share of payment adjusted in their Medicare Part B Fee-for-Service (FFS) claims in the year 2023.  

Exception Cases that Don’t Strictly Qualify for MIPS 2021 Reporting

The MIPS 2021 data submission does not strictly rely on the following exclusive cases.

Newly-enrolled Medicare eligible clinicians who qualify to participate in the Medicare program for the first time

MIPS eligible clinicians and groups who do not pass the low-volume performance threshold:

Medicare Part B allowed charges ≤ $90,000

Provide healthcare to 200 or fewer Medicare Part B patients

Provide fewer than 200 covered professional services to Part B patients

Eligible clinicians who are participating in Advanced APMs

No Recognition via Physicians’ Portal

Another way to look at the MIPS 2021 participation is an opportunity to be listed in the Physicians’ Portal. Physicians’ name in this interface is not just a listing. But a position that implies you have been recognized among the top performers in the healthcare industry.

With this comes the easy position in the insurance networks. The easily you are recognized, the more patients you can cater to. 

Altogether, where MIPS 2021 reflects the value-based care system, it ultimately compensates via incentives and high patient volume.

No Qualification of the Bonus Pool of Worth $500 Million

There have been flexibilities in the MIPS 2021 data. However, if physicians do not report data, they can lose qualification for the $500 million bonus pool.

Imagine how far this little investment can take a physician. It’s not just about Medicare incentive payment program participation. It’s also about empowering patients and steering through the hectic reporting requirements.

Merit-based incentive program by QPP has set a payment adjustment percentage each year. It gives positive reimbursement payments to those who fulfill the criterion and successfully submit the measures in both phases of MIPS. However, Covid 19 has hampered the penalty phase-in and substantive bonus payment for the MIPS 2020 and 2022. CMS has also forwarded Extreme and Uncontrollable Circumstances exclusion for those MIPS-eligible clinicians who were reporting in pandemic days and giving the best of their care to patients. These circumstances have been changed for MIPS 2023 as we have overcome the diverse effects of Covid-19. CMS wants to completely implement the MIPS program. This time, it has decided on up to a 9% payment adjustment in the form of penalties and bonuses for all participating clinicians. CMS has updated the MIPS 2023 in such a way that after scaling from 1 to 100 in the final MIPS score, half of the clinicians will get penalties and will be rewarded with bonuses. It means MIPS 2023 has updated the level a little bit. For now, clinicians have to get at least 75 points to avoid penalties while scores above this limit will contribute to positive payment. 

Conclusion

Physicians! The worth that MIPS 2021 participation can lend physicians is intertwined not just with financial intricacies but also the empowerment of care delivery. Even if you are not ready for data submission, one can consult a MIPS Qualified Registry to try to achieve the minimum performance threshold to report their data. Moreover, with decent MIPS performance, medical practices can unlock high MIPS scores.

Read more: How Can You Qualify for the MIPS 2021 Exception Applications?