MIPS 2018 update: Revised claims codes for quality measure reporting

Tags: Merit-based Incentive Payment System, MIPS quality measure, QDC, TMF, TMF Health Quality Institute

By TMF Health Quality Institute

Eligible clinicians participating in the Merit-based Incentive Payment System who plan to report MIPS quality measures using claims should be aware that some claims codes have changed for the 2018 performance period. Following are answers to common questions about the claims-based reporting.

Question: We noticed some of the 2018 Quality Data Codes for claims submissions have changed. If my practice submits claims using the previous codes, will they count toward our MIPS quality measure submission for the 2018 period?

Answer: If you have submitted the claim and it has been processed, you cannot resubmit solely to add or correct the QDC. You should switch to the correct codes as soon as possible to ensure you meet the measure’s data completeness requirement of 60 percent for the 2018 performance year.

Q: How do I know if my claims submissions count toward my MIPS quality measure requirements?

A: When the claim is processed and you are credited for the measure, you will receive an N620 follow-up code stating, “This procedure code is for quality reporting/informational purposes only.” This code indicates the QDC codes are valid; it does not mean the QDC code was correct or that you met the measure requirement. Keep track of submitted cases so that you can verify QDCs reported against the remittance advice notice sent by the Medicare Administrative Contractor.

Q: Is it too late to begin MIPS claims submissions for 2018?

A: The most important component of MIPS quality measure reporting is the 60 percent data completeness requirement. That means 60 percent of a MIPS-eligible clinician’s patients who meet the denominator criteria for the measure must be included, regardless of payer, for the 2018 performance period. If you begin billing using the appropriate codes early in the period, you have a good chance of meeting this criteria. The Centers for Medicare and Medicaid Services released updated measure specifications on Dec. 27, 2017. Find these on the CMS QPP Resources webpage.

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Contact TMF for resources, tools and assistance for claims-based reporting and other Quality Payment Program topics.

Submit a TMF Request for Support.

Email QualityReporting@tmf.org (practices with 16 or more eligible clinicians) or QPP-SURS@tmf.org (practices with 15 or fewer eligible clinicians).

Call (844) 317-7609 or live chat with a TMF consultant, Monday - Friday, 8 a.m. – 5 p.m. CT.

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