Will You Get a Medicare Bonus or Pay Cut Next Year?
By David Doolittle


If you participated in the 2018 Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program (QPP), it’s now possible to check whether you’ll receive a Medicare payment bonus or cut next year. 

Physicians should check their 2018 MIPS performance feedback and 2020 payment adjustment as soon as possible in case the Centers for Medicare & Medicaid Services (CMS) made mistakes when calculating your data, which happened last year

A mistake would affect the amount of your Medicare bonus or cut next year. Or worse, result in a cut when you should receive a bonus. And because MIPS scores also are reported annually on the Physician Compare website, you’ll want to ensure CMS got it right. 

If you find errors, request a “targeted review” by Sept. 30. That means CMS will review your information again and make corrections accordingly. For complete details about this process, refer to CMS’ 2018 Targeted Review Fact Sheet and the 2018 Targeted Review FAQs

Your 2018 MIPS final score will determine whether you receive a bonus or cut of up to 5%, which will be applied to your Medicare payments for covered professional services furnished under the Medicare physician fee schedule (on a per claim basis) next year. 

MIPS final scores cover a 0- to 100-point scale. As the QPP evolves over time, the number of points needed to avoid a pay cut and receive an incentive payment and additional bonus will steadily increase over the next few years. Of note, because the QPP is still ramping up, bonuses may not be as high for the second year of the program. 

For the 2018 performance year, you need:

  • A final score of at least 15 points to avoid a pay cut in 2020;
  • A final score between 15.01 and 69.9 for an incentive payment; and
  • A final score between 70 and 100 for an incentive payment plus an additional bonus for exceptional performance. 

If you participated in regular MIPS or a MIPS alternative payment model (APM) in 2018, you can see how you scored by going to the QPP portal and logging in using your HCQIS Access Role and Profile (HARP) system credentials, which are the same credentials that allowed you to submit your 2018 MIPS data. If you don’t have a HARP account, refer to the QPP Access User Guide (zip file) and start the process now. 

Physicians who participated in an advanced APM in 2018 and achieved qualifying APM participant (QP) status were exempt from MIPS. These physicians should contact their APM administrator to ask about the 5% advanced APM bonus (one lump sum payment) and their APM-specific rewards. Physicians who achieved partial QP status and did not elect to participate in MIPS will not receive MIPS performance feedback. These physicians should check with their APM administrator for details on how to achieve full QP status moving forward to earn the 5% advanced APM bonus. 

Lastly, the Texas Medical Association recommends that you not rely on MIPS-related vendors to tell you how you fared. To the extent possible, take control of your MIPS information. You should review your own MIPS data to inform quality improvement efforts in your practice and to help you select the right MIPS measures and improvement activities for 2019 and future years of the program. 

For general questions, contact the QPP Service Center at (866) 288-8292 or QPP[at]cms[dot]hhs[dot]gov.  

For free help on how to interpret your performance feedback and final score or how to request a targeted review, contact MIPS experts at the TMF Health Quality Institute

As always, visit the TMA MACRA Resource Center for all things QPP.

Last Updated On

July 11, 2019

Originally Published On

July 11, 2019

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