News & Insights

Here we are again … in the crosshairs of QPP!

February 17, 2021

Natalie Cohen, LAMMICO Practice Management Specialist

Here we are again … in the crosshairs of QPP!
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Below are a few important key items to remember before we get too far into 2021:

2019: Payment Adjustments Realized

  • 2019 payment adjustments are now being realized on 2019 Medicare Part B remittance advices (RA)
  • Review the CARC and RARC messages. Positive MIPS payment adjustments are designated as 144 Incentive adjustment and N807 Payment adjustment based on MIPS. Negative MIPS payment adjustments are displayed on RAs as 237 Legislated/Regulatory Penalty. If you did not submit data in 2019 and didn’t claim an exception, you may see a 7% reduction to most Part B payments in 2019.

Additional Resources
Performance, Payments and Posting: How to Read Your 2021 Medicare Remittance Advices (January 5, 2021) 

2020: Submission Window Open Now

  • The QPP portal is open. Eligible clinicians and groups can now submit and attest to 2020 MIPS measures and activities. The portal will close March 31, 2021.
  • Louisiana providers were granted automatic exceptions for the 2020 performance year due to Hurricane Laura. However, if an eligible clinician submits data in more than one performance category for 2020, the data will nullify the exception.
  • Providers in Arkansas and around the country were able to apply for exceptions for any Extreme and Uncontrollable circumstance (such as COVID-19), for one or more of the MIPS performance categories in 2020.
  • If you don’t have an exception AND you do not report, you could face a 9% penalty on future Medicare claims.

Additional Resources

The CMS Announcement We Were Waiting For … Louisiana Providers May Not Have To Report MIPS For 2020! (November 18, 2020)

MIPS Eligible Clinicians ... Don’t Lose 9% of Your Medicare Payments! (November 6, 2020)

2021: Data Collection Needed

  • Get started reporting Quality! It is the only performance category in MIPS that requires a full year of data collection.
  • CMS has indicated that the Extreme and Uncontrollable Circumstances Policy exception based on COVID will continue in 2021, but it will not be automatic. We expect the application to be available in Spring 2021 along with additional resources.
  • What's new?
    • Final score calculation:  
  • 60 points needed to avoid a penalty
  • 85 point threshold to earn exceptional performance bonus
  • 9% negative payment adjustment on all Medicare Part B services in 2023 for eligible clinicians who don't submit data or are granted an exception
  • Introduction of the new APM Performance Pathway for MIPS eligible providers participating in an APM
  • New Quality and Improvement Activity measures and a new optional measure is added for Promoting Interoperability

Remember …

  • You don't have to have an EHR to avoid a penalty or earn a positive adjustment or bonus.
  • It does not have to cost you any money to submit data.

To help our insureds navigate QPP, LAMMICO will offer a complimentary webinar, “QPP and Revenue Cycle Q & A for Physicians and Practice Staff “on Wednesday, March 3, 2021, at noon. The webinar will be presented by LAMMICO Practice Management Specialist Natalie Cohen, MBA, MHA.

Webinar registration is required. Webinars are provided at no cost to LAMMICO insureds. If possible, please register at least 24 hours in advance of the webinar. To register for a webinar listed above, log in as a Member and select "Webinars" from the drop-down menu under your name if you are using a desktop or laptop computer or tablet.

If you are an eligible clinician, a LAMMICO insured and have not already implemented a process for capturing or reporting MIPS data in your practice, contact LAMMICO and let us help you! There is no charge for our consultation. These services are provided to you because you are a LAMMICO insured.

Participation in the Quality Payment Program can also help you mitigate your malpractice risk through tracking and improving quality care (Quality measures), increasing patient engagement and satisfaction (Improvement Activities) and improving communications using secure electronic transmissions between providers and with patients (Promoting Interoperability).

Contact LAMMICO Practice Management Specialist, Natalie Cohen, MBA, MHA, at 504.841.2727 or

This content is accurate as of February 17, 2021. 

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