Medicare Compliance & Reimbursement

The Centers for Medicare & Medicaid Services (CMS) intends to reweight the cost category to zero for the 2021 performance year/2023 payment year, the agency noted in an April 25 email alert.

“Due to COVID-19’s impact on cost measures, we’re reweighting the cost performance category from 20 percent to 0 percent for the 2021 performance period. The 20 percent cost performance category weight will be redistributed to other performance categories,” CMS said in the update.

CMS had already reweighted the cost category for individual Merit-Based Incentive Payment System (MIPS)-eligible clinicians as part of its extreme and uncontrollable circumstances (EUC) policies.

In addition, “our analysis of the underlying data for the 2021 performance period shows similar results at the group- and individual-level across measures. As a result, we believe that reweighting shouldn’t depend on whether you choose to report as a group or individual,” CMS said.

And for this reason, the agency is opting to reweight the cost category beyond the EUC policies and include both group and virtual group practices in the update.

Since this is the second year that CMS has reweighted the cost category to zero, the agency plans to “provide patient-level reports on the 2021 cost measures for which clinicians, groups and virtual groups met the case minimum. Patient-level reports will be available as part of the final performance feedback in August 2022,” the alert says.