MIPS: Opt-In Options for 2019

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The Quality Payment Program (QPP) is offering an option to “Opt In” in 2019. A practice or clinician that does not exceed the low-volume threshold is not required to report but could have the choice to opt in to report as an individual or a group. By opting in, the clinician can receive a payment adjustment (positive or negative) on reimbursement for CMS Medicare Part B patients. The clinician can also choose to voluntarily report as an individual or a group, and not receive any payment adjustment, but be eligible to see benchmarking data from peers.

What is the Opt-In Option?

The Quality Payment Program (QPP) is offering an option to “Opt In” in 2019. A practice or clinician that does not exceed the low-volume threshold is not required to report but could have the choice to opt in to report as an individual or a group. By opting in, the clinician can receive a payment adjustment (positive or negative) on reimbursement for CMS Medicare Part B patients. The clinician can also choose to voluntarily report as an individual or a group, and not receive any payment adjustment, but be eligible to see benchmarking data from peers.
 

How Do We Find Out If We Can Opt In?

Look at your QPP participation status, using your 10-digit National Provider Identifier (NPI) to see if you are required to report by status year. You will see your participation status and if you are eligible to opt in.
 

What are the Pros and Cons of Opt-In vs. Voluntarily Reporting?

Opt-In:

  • The decision to opt in must be designated clearly with CMS prior to any data submission, and once you opt in, you cannot revoke your status for the current performance year
  • Opting in will make you fully eligible for any earned upward payment adjustments, but will conversely make you responsible for any downward payment adjustments
  • Eligibility can change annually, so clinicians and practices may use the option to prepare themselves for reporting
  • All data will be used in the Physician Compare website 

Voluntarily Reporting:

  • You do not have to pre-notify CMS of your decision
  • You are not eligible for any positive payment adjustments, but also not penalized for negative payment adjustments
  • You will get feedback reports on the categories on which you submit data, but your data is not used for any benchmarks for future reporting years
  • Clinicians can decline having their data and performance scores reported on the Physician Compare site