The traditional Merit-based Incentive Payment System (MIPS) comprises four performance categories: Quality, Cost, Promoting Interoperability (PI), and Improvement Activities (IA).
Performance across these MIPS categories will result in a MIPS final score, which determines whether the Centers for Medicare and Medicaid Services (CMS) will apply a negative, neutral, or positive MIPS payment adjustment to your reimbursements. MIPS reporting for 2022 will determine payment adjustments in 2024.
For the 2022 performance year, CMS will generally weigh the performance categories for a MIPS-eligible clinician, group, and virtual group (collectively called providers) as follows:
- 30% for the Quality performance category (a 10% decrease from performance year 2021).
- 30% for the Cost performance category (a 10% increase from performance year 2021).
- 15%for the IA performance category (same as performance year 2021).
- 25% for the PI performance category (same as performance year 2021).
The Quality performance category assesses quality of care based on measures of performance. Providers may select from 200 quality measures for the 2022 performance period. For Medicare Part B claims measures, MIPS clinical quality measures (CQMs), electronic CQMs, or Qualified Clinical Data Registry measures, providers must report data on at least six measures, including one outcome measure (or one other high-priority measure if an applicable outcome measure is not available). If fewer than six measures apply to the provider, report on each measure that is applicable.
Similarly, providers have the option of submitting data on certain measures within a specialty measure set, which is a group of quality measures applicable to a specific specialty. Providers who choose to submit a specialty measure set must report data on at least six measures within that set, including at least one outcome measure (or one other high-priority measure if an applicable outcome measure is not available). If fewer than six measures within the set apply to the provider, the provider must report on each measure that is applicable.
Although the specialty measure set helps providers identify measures that may be applicable to their practice, providers are not limited to reporting measures within the Allergy/Immunology Specialty Measure Set. For the 2022 performance period, the Allergy/Immunology Specialty Measure Set contains thirteen measures.
High-Priority Measure: Process
1. Adult Sinusitis: Antibiotic Prescribed for Acute Viral Sinusitis (Overuse)
2. Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use)
3. Closing the Referral Loop: Receipt of Specialist Report
4. Documentation of Current Medications in the Medical Record
5. HIV Medical Visit Frequency
6. Use of High-Risk Medications in Older Adults
High-Priority Measure: Outcome
7. Optimal Asthma Control
8. HIV Viral Load Suppression
Process Measure
9. Pneumococcal Vaccination Status for Older Adults
10. Preventive Care and Screening: Influenza Immunization
11. Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
12. Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
13. Tobacco Use and Help With Quitting Among Adolescents
It is important for providers to explore available quality measures to determine which ones best fit their practice. For more information on MIPS measures, please refer to the Quality Payment Program’s (“QPP”) Measures and Activities Tool.
For additional information on the MIPS program in general, please refer to the QPP Resource Library. Those in smaller practices can refer to special policies for small practices.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
