Earlier this summer the Centers for Medicare and Medicaid Services (CMS) published the 2023 Medicare Physician Fee Schedule proposed rule recommending a number of changes to the Quality Payment Program (QPP), including the traditional Merit-based Incentive Payment System (MIPS) program. As a refresher, traditional MIPS comprises four performance categories: Quality, Cost, Promoting Interoperability (PI) and Improvement Activities (IA). A provider’s score for each of these categories determines one’s total MIPS score and corresponding payment adjustment.
This article provides a summary of CMS’s proposed changes to the QPP concerning performance category weights and the performance threshold for the traditional MIPS program.
Performance Category Weights
For the 2023 performance year, CMS is required to weigh the cost and quality performance categories equally. Accordingly, for individuals, groups, and virtual groups, CMS will weigh the performance category as follows. The percentages are the same as performance year 2022.
- 30% for the quality performance category
- 30% for the cost performance category
- 15% for the IA performance category
- 25% for the PI performance category
Performance Threshold
For the 2023 performance year, CMS proposes to keep the performance threshold at 75 points. The 2022 performance year was the last year that CMS provided an additional MIPS payment adjustment for exceptional performance. Accordingly, under the proposal, clinicians and group practices must receive at least 75 points to avoid a negative payment adjustment for the 2025 payment year.
| Final Score 2023 (Proposed) | Payment Adjustment 2025 (Proposed) |
|---|---|
| 75.01 – 100 points | Positive adjustment greater than 0% Not eligible for additional payment for exceptional performance |
| 75 points | Neutral payment adjustment |
| 18.76 – 74.99 points | Negative payment adjustment between -9% and 0% |
| 0 – 18.75 points | Negative payment adjustment of -9% |
View the full document for more information on the 2023 QPP proposed rule. Watch for a future Advocacy Insider discussing CMS’s proposals concerning the Medicare Physician Fee Schedule.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
