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Payment for quality: Changes to Medicare’s Merit-based Incentive Payment System

For 2021, higher incentives for exceptional performers and new neuropsychology specialty measures provide an opportunity for increased return on investment, but performance expectations are increasing.

Cite this
Owings-Fonner, N. (2021, January 29). Payment for quality: Changes to Medicare’s Merit-based Incentive Payment System. https://www.apaservices.org/practice/reimbursement/government/medicare-changes-payment-system

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The Centers for Medicare and Medicaid Services’ (CMS) final rule on the 2021 physician fee schedule included only minor changes to Medicare’s Quality Payment Program but they could have big impact on providers’ reimbursements.

If you are a psychologist providing treatment to Medicare patients, here are the top things to know about how your reimbursement may be impacted by the Merit-based Incentive Payment System (MIPS) in 2021.

Exemptions and the low-volume threshold (LVT) remain the same as for 2020

This year, psychologists will be exempt from MIPS if in 2020 they:

  • treated 200 or fewer Medicare Part-B beneficiaries,
  • billed Medicare Part-B for $90,000 or less in allowed charges, or
  • provided 200 or fewer covered professional services.

You may also choose to opt-in if you fall under the LVT but still want to participate in MIPS to potentially receive reimbursement incentives. To opt in, a provider only has to meet one of the LVT criteria (i.e. provide 200 or more covered professional services).

The performance threshold is increasing

The performance threshold is increasing from 45 to 60 points and exceptional performance is 85 points. This change will make it harder to avoid a penalty but will also increase the incentive payment for those who achieve a high score. With this change, CMS predicts that exceptional performers will receive up to a 7.36% increase on 2023 Medicare payments.

Two new neuropsychology process measures are now available in APA’s Mental and Behavioral Health Registry (MBHR)

Working in partnership with the National Academy of Neuropsychology’s Professional Affairs and Information Committee, APA and the MBHR Advisory Committee created two additional process measures to help address measurement gaps in MIPS for neuropsychologists:

  • cognitive assessment with counseling on safety and potential risk, and
  • patient feedback of test results following cognitive or mental status assessment.

In addition to the standard MIPS measures available to neuropsychologists, these two new measures and 10 other mental and behavioral health specialty measures are available only in the MBHR.