MIPS 2023 Final Rule Released

On Tuesday, November 1, 2022, the Centers for Medicare & Medicaid Services (CMS) released the Final Rule for the 2023 Quality Payment Program (QPP). Below is a summary of some of the 2023 Performance Year (PY) QPP Final Rule changes and updates:

Traditional MIPS

Performance Threshold

• 75 points to avoid up to a -9% penalty of Medicare reimbursements for covered professional services in 2025
• Starting 2023, an eligible clinician or group can no longer earn an additional MIPS adjustment for exceptional performance.

Quality Category (30% of overall MIPS Score)

• Removed measures will include:
  • 147 — Preventative Care and Screening: Influenza Immunization (retained for MVPs only)
  • 127 — Pneumococcal Vaccination Status for Older Adults (retained for MVPs only)
• New measures will include:
  • Adult Immunization Status (Influenza; tetanus and diphtheria (Td) or tetanus, diphtheria and acellular pertussis (Tdap); zoster; and pneumococcal) 
• Changes to measure scoring:
  • Measures with a benchmark can now be scored from 1-10 points (previously 3-10 points) if data completeness and the case minimum are met. 
    • This does not apply to new measures in the first two performance periods
  • Measures without a benchmark or that don’t meet the case minimum will receive zero points (previously 3)
    • Exception for small practices who will continue to earn 3 points
    • This does not apply to new measures in the first two performance periods

Promoting Interoperability Category (25% of overall MIPS Score)

• Changes to the scoring of individual measures
• Health Information Exchange Objective:
  • Adding a 3rd option for meeting this objective; Participation in the Trusted Exchange Framework and Common Agreement (TEFCA)
• Query of Prescription Drug Monitoring Program (PDMP) measure: 
  • Required in 2023 (exclusions available)
  • Expanding to include not only Schedule II opioids but also Schedules III and IV drugs
• Public Health and Clinical Data Exchange Objectives will now require the Eligible Clinician/Group to report their level of active engagement
• Electronic Case Reporting: CMS removed the exclusion for Eligible Clinicians who use CEHRT not certified to the electronic case reporting certification criterion

MIPS Value Pathways (MVPs) 

To report an MVP, an MVP Participant will register for the MVP between April 1 and November 30 of the performance year, or a later date as specified by CMS. 

Revisions to previously finalized MVPs:

1. Advancing Care for Heart Disease 
2. Optimizing Chronic Disease Management MVP 
3. Advancing Rheumatology Patient Care
4. Improving Care for Lower Extremity Joint Repair
5. Adopting Best Practices and Promoting Patient Safety within Emergency Medicine
6. Patient Safety and Support of Positive Experiences with Anesthesia 
7. Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes 

Newly finalized MVPs:

1. Advancing Cancer Care 
2. Optimal Care for Kidney Health 
3. Optimal Care for Patients with Episodic Neurological Conditions 
4. Supportive Care for Neurodegenerative Conditions 
5. Promoting Wellness 

For the 2023, 2024, and 2025 MIPS performance years, CMS will define an MVP Participant as a:

• Individual clinician 
• Single specialty group 
• Multispecialty group 
• Subgroup 
• Alternative Payment Models (APM) Entity 

For more information on the 2023 Final Rule, please visit qpp.cms.gov and be on the lookout for our 2022 MIPS Submission and 2023 Final Rule webinar!

MIPS Advisory Services

With ModMed’s MIPS Advisory Services, a dedicated advisor can help you meet your goals! MIPS Advisors, who are trained in gGastro®, can work with you to build your practice’s custom MIPS project plan and answer questions, monitor your performance, and more. Fill out the form here to get in touch with the MIPS team.