E/M Coding Alert - 2021 Issue 6
Mythbusters: Debunk 5 QPP Myths With These Facts
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Article Overview
This premium article explains current Quality Payment Program guidance and clarifies five frequently misunderstood issues affecting MIPS and related participation pathways during the COVID-19 period. It is aimed at clinicians, group practices, and coding or compliance staff who need a broad understanding of reporting status, exceptions, and payment-adjustment considerations without relying on outdated assumptions. The article covers CMS updates, special status assignment, exception applications, and performance-year reporting frameworks.
Why This Topic Matters
Accurate QPP knowledge affects whether providers submit data correctly, qualify for special status, and understand how pandemic-era exceptions may influence performance scoring and payment adjustments.
Article Sections
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Introduction
Introduces the article’s focus on common Quality Payment Program misunderstandings and the broader context of CMS updates during the pandemic period.
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Myth 1: Regular MIPS is going away in 2022.
Discusses reporting framework changes and the timing of CMS pathway updates for upcoming performance years.
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Myth 2: There will be no bonus pay for PY 2020.
Covers pandemic-related scoring accommodations and bonus-related policy updates affecting the 2020 performance year.
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Myth 3: Only small practices get ‘special status’ under MIPS.
Explains how special status determinations are associated with provider data, determination periods, and broader eligibility categories.
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Myth 4: An EUC application can erase MIPS providers’ 2020 submissions.
Addresses how extreme and uncontrollable circumstances applications relate to submitted data and performance category treatment.
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Myth 5: If an individual clinician leaves a group in PY 2020, the MIPS payment adjustment goes to the group for payment year 2022.
Reviews how group and individual submissions are handled when clinicians move between practices, including implications for later payment years.
What You Will Learn
- How CMS updates affect Quality Payment Program reporting
- Which broad MIPS and APM-related pathways are discussed
- How special status determinations are described in QPP guidance
- How exception applications and pandemic-era accommodations are framed
- How group and individual reporting relationships are addressed in the article
Who Should Read This
- Clinicians participating in MIPS
- Medical group administrators
- Compliance and coding staff
- Quality reporting personnel
- Practices tracking QPP updates
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