Facility-based Scoring for Providers Who Perform Their Services in a Hospital
March 28, 2019
Written by Sharon Phelps
Important information for providers who perform the majority of their services in a hospital.
In 2019, hospital providers have a new option for Merit-based Incentive Payment System (MIPS) in the Quality and Cost categories called “facility-based scoring.” Facility-based scoring provides clinicians with scores in the MIPS Quality and Cost categories using quality measures from the hospital value-based purchasing (HVBP) program.
Facility-based Quality and Cost scoring is available for clinicians who provide services in a hospital setting. Hospital setting is determined by the place of service on the claim and includes:
- Inpatient hospital (Place of Service [POS] = 21)
- On-campus outpatient hospital (POS= 22)
- Emergency room (POS=23)
There are three criteria to be eligible for facility-based scoring:
- You billed at least 75 percent of your covered professional services in a hospital setting.
- You billed at least one service in an inpatient hospital or emergency room.
- You can be attributed to a facility with a HVBP score.
For the 2019 MIPS performance year, the determination period for facility-based measurement is based on Medicare Part B claims billed by clinicians between October 1, 2017 and September 30, 2018 (including a 30-day claims run out).
If you believe you may be eligible for facility-based scoring, you can use the Medicare Quality Payment Program (QPP) Participation Status look-up tool. The tool will indicate if you have the special status of “hospital-based” and will list the facility with which you are associated for facility-based scoring. This eligibility is listed at the clinician (individual) and practice (group) levels. If 75 percent or more of the providers in your group are considered facility-based, you can use facility-based scoring for reporting at the group level.
Here is the BEST news! Centers for Medicare & Medicaid Services (CMS) will automatically calculate Quality and Cost scores for providers who are determined to be facility-based and will upload these values to the QPP portal for 2019 MIPS reporting. While CMS has not committed to an exact date for publishing these scores for the 2019 MIPS performance year, these scores will be visible in the QPP portal before the end of the 2019 submission window.
More good news: you can elect to submit quality measure data using other methods, and CMS will give you the highest score from all data submitted. If your practice reports at the group level, but your facility-based scores at the individual level give you a higher final score, you get the highest score.
Are you curious how this might affect you? Log in to your secure account on the qpp.cms.gov portal (under the Sign-In button) to find the currently available preview data for 2018. While this data and these scores will NOT be used in 2018, it is real data and gives you a preview of how the scores will be calculated next year. Typically, preview data is only available for 30 days, so log in soon to get a glimpse of this new option!
Find more information about this topic in our recent MIPS Tips session. You can review the slide deck and listen to the recording here.
If you have further questions, please feel free to contact our team of MIPS experts at email@example.com. We are here to help you be successful with MIPS and enjoy answering your questions and supporting your MIPS activities.