2020 Quality Requirements

What Quality Data Should I Submit?

Merit-based Incentive Payment System (MIPS) Quality Measure Data

You must collect measure data for the 12-month performance period (January 1 – December 31, 2020).

There are 6 collection types for quality measures:

• Electronic Clinical Quality Measures (eCQMs),
• MIPS Clinical Quality Measures (CQMs),
• Qualified Clinical Data Registry (QCDR) Measures,
• Medicare Part B claims measures,
• CMS Web Interface measures and;
• The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS survey.

General reporting requirements (for those not reporting through the CMS Web Interface):

• You will typically need to submit collected data for at least 6 measures (including 1 outcome measure or high-priority measure in the absence of an applicable outcome measure), or a complete specialty measure set.
• You will need to report performance data for 70% of the patients who qualify for each measure (data completeness).
• You can submit measures from different collection types (except CMS Web Interface measures) to fulfill the requirement to report 6 measures.

We will automatically calculate and score groups and virtual groups with 16 or more clinicians on a 7th measure, the All-Cause Hospital Readmission measure, when the group or virtual group meets the case minimum for the measure.

EHR-based Quality Reporting

If you transition from one EHR system to another during the performance year, you should aggregate the data from the previous EHR and the new EHR into one report for the full 12 months prior to submitting the data. If a full 12 months of data is unavailable (for example if aggregation is not possible), your data completeness must reflect the 12-month period. If you are submitting eCQMs, both EHR systems must be 2015 Edition CEHRT.

Specialty Measure Sets

If you choose to submit a specialty or subspecialty measure set, you must submit data on at least 6 measures within that set. If the set contains fewer than 6 measures, you should submit each measure in the set.

CMS Web Interface

If your practice or virtual group registers for the CMS Web Interface, you must report all 10 required quality measures for the full year (January 1 – December 31, 2020).

Learn more and register for CMS Web Interface

CAHPS for MIPS Survey

If your practice or virtual group registers for and meets the sampling requirements for the CAHPS for MIPS survey, this can count as one of the 6 required measures, or can be reported in addition to the 10 measures required for the CMS Web Interface. Learn more and register for the CAHPS for MIPS survey.

How Should I Submit Data?

There are 4 submission types you can use for quality measures, depending on what submitter type you are. The submission types are:

• Medicare Part B claims
• Sign in and upload
• CMS Web Interface
• Direct submission via API

Determine how to submit data based on your submitter type below.

You’re a MIPS Eligible Clinician

You’re a Representative of a Practice or Virtual Group

* CMS Web Interface only

You’re a Representative of a MIPS APM Entity

You’re a Third-party Intermediary

We determine measure achievement points by comparing performance on a measure to a measure benchmark.

If a measure can be reliably scored against a benchmark, it generally means:

• A benchmark is available,
• Has at least 20 cases, and;
• Meets the data completeness requirement standard, which is generally 70%.

CMS Web Interface measures are scored against the Shared Savings Program benchmarks.

Bonus Points

You can earn quality bonus points in the following ways:

• Submit 2 or more outcome or high priority quality measures.
  • This bonus is not available for the first, required outcome or high priority quality measure.
  • This bonus is not available for measures required by the CMS Web Interface, but is available to groups that report the CAHPS for MIPS survey in addition to the CMS Web Interface measures.
• Submit using End-to-End Electronic Reporting, with quality data directly reported from a certified EHR technology (CEHRT).

Six bonus points are added to the Quality performance category score for clinicians in small practices who submit at least 1 measure, either individually or as a practice or virtual group. This bonus is not added to clinicians or groups who are scored under facility-based scoring.

You can also earn up to 10 additional percentage points based on your improvement in the Quality performance category from the previous year.

When Will Facility-Based Measures Scoring Apply?

We will continue to identify clinicians and practices eligible for facility-based scoring. These clinicians and practices may have the option to use facility-based measurement scores for their Quality and Cost performance category scores.

Facility-based measurement scoring will be used for your Quality and Cost performance category scores when:

• You’re identified as facility-based,
• You’re attributed to a facility with a FY 2021 Hospital Value-Based Purchasing (VBP) Program score, and;
• The Hospital VBP Program score results in a higher combined Quality and Cost score than the MIPS Quality measure data you submit and MIPS Cost measure data we calculate for you.