MACRA QPP Center

Physicians Advocacy Institute

Frequently Asked Questions Updated for 2020

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5. What is the minimum I have to do to avoid the MIPS penalty in 2020?

  1. CMS no longer offers the “test” and “partial” participation options that were available as part of the 2017 transition year policies. Physicians’ MIPS scores are determined on their overall performance in each of the four MIPS categories compared to the CMS performance threshold score for a given year. Physicians will receive a score in each category, and their MIPS final score will be the sum of the weighted score of each category. For 2020, CMS set the performance threshold at 45 points.
     
    The performance threshold is considerably higher in 2020. We suggest reporting measures to some capacity within all performance categories to ensure you reach 45 points and avoid a negative payment adjustment in 2022. It is possible to reach the 45-point threshold if you decide to skip one category. For example, if you currently do not utilize a CEHRT of 2015 Edition certification, thus producing a 0 for your PI score, you may still be able to reach 45 points by reporting measures within the remaining quality, and improvement activity categories (as well as through your cost score, which is claims-based; therefore, it does not require reporting on your end).

    Examples of ways to achieve the minimum of 45 points:
    • 100% score in the improvement activities category (15 points towards your total MIPS score), as well as in the PI category (25 points towards your total MIPS score), and a 12% score in Quality (or a 34% score in Cost). This would equal ~45-46 points for your MIPS overall score.
    • Achieving the maximum 60 out of 60 total points (if reporting 6 measures) for the quality category (this would equate to 45 points, exactly, for your total MIPS score).

    For additional details on scoring and the requirements for each of the categories, see the resources available on PAI’s QPP Resource Center.



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