MIPS 2019 Results: Questions and Answers

December 21, 2020
 / 
Rick Gawenda
 / 

If you are a physical therapist, occupational therapist or speech-language pathologist in private practice and you participated in the 2019 Merit-Based Incentive Program (MIPS), you have now received your MIPS score and payment adjustment percentage for calendar year 2021. In this article, I will answer several questions that I have been receiving to help you understand what will be occurring in 2021.

Question
Is it possible for a therapist who has their own individual NPI number, is employed or contracted by multiple private practices (different TINs) and submitted claims to Medicare under each NPI/TIN combination to have different MIPS scores for each practice and subsequently, different payment adjustments for each practice they are employed or contracted at?

Answer

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Question
What if a therapist who received multiple MIPS scores in Performance Year 2019 resulting in different payment adjustments for the practices they are working at that will affect the 2021 Payment Period now begins practicing at a new private practice in calendar year 2021, which payment adjustment follows them to this new NPI/TIN combination?

Answer

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Question
Is the MIPS payment adjustment applied to the Medicare paid amount or Medicare allowed amount for each CPT code?

Answer

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Question
Is the MIPS payment adjustment applied before or after sequestration?

Answer

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Question
How will 2021 MIPS payment adjustments be reflected on remittance advice (RA) documents?

Answer

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Question
What if I was required to participate in MIPS in 2019 and did not submit my data to CMS? Will I receive a -7% payment adjustment in 2021?

Answer

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Question
What if we were required to report MIPS and were going to report as a Group in Performance Year 2019, but did not submit the data. Will we receive a -7% payment adjustment in 2021?

Answer

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I hope you found this article informative and helpful to your practice. Thank you for being a Gold Member!


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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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