Highlights from the 2022 MIPS Final Rule: Performance Categories - Quality and Cost

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Quality: The Centers for Medicare & Medicaid Services (CMS) is required by mandate to make the Quality and Cost performance measures each worth 30 percent of the Total Composite Score in 2022. In addition, CMS removed the End to End and High Priority Bonus points in this category with the rationale being that it will make scoring fairer. Small practices will continue to receive the Small Practice Bonus of six points. Eligible Clinicians will continue to report on at least one High-Priority Bonus Measure, with no Bonus Points for additional reported measures.

Submission data from the 2020 Performance Year was considered enough for CMS to create benchmarks. The benchmarks will help practices estimate their scores through this coming year. 

CMS is encouraging providers to report on new measures by proposing a seven-point minimum/floor for the first year the measure is available for reporting (previously it was three points) and a five-point floor for the second year the measure is available for reporting. There are no scoring changes in 2022 to existing measures (with or without benchmarks) or to existing measures that do not meet case minimums.

Cost: As stated under the Quality category, the Cost performance measures are 30 percent of the Total Composite Score in 2022. CMS is looking for provider input to redefine some cost measures for implementation by the 2024 performance period, in addition to their current processes for developing cost measures.

There were five new Episode-Based Measures added for 2022, including melanoma resection; colon and rectal resection; sepsis; asthma/COPD; and Diabetes. These fall under either procedural, acute inpatient medical condition or chronic condition measures.

Chronic condition episode-based measures (like asthma or diabetes) are attributed to the physician group that renders the services under a “trigger event.” That event occurs when two claims are billed by the same clinician group within 180 days of each other – the initial evaluation and management (E/M) code and a second claim with another E/M code or condition-related CPT/HCPCS code for related procedures or management.

The chronic condition attribution can extend for multiple years, divided into a segmented series of episodes.

The above information was taken from a webinar – Quality Reporting Engagement Group 2022 MIPS Final Rule, presented in December 2021.  For more information or answer to questions, contact the team of experts at info@intrinsiq.com.