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MIPS 2020 Reporting Checklist for Optometrists

Each year brings new challenges, regulations, and quality parameters.

Optometrists like other healthcare professionals have to look into updates and revise strategies to maximize revenue. QPP MIPS reporting is also one of those programs that need attention right from the start of the year.


For MACRA MIPS, two sets of rules apply; the proposed rule and the final rule that comes into effect on January 1st of every year.

These rules are not only a lot to grasp on but require a cohesive strategy for implementation. Therefore, MIPS Qualified Registries are there to go through thousands of pages for MIPS reporting. Let’s begin the checklist for MIPS 2020 for optometrists without wasting any more time.

Let’s begin the checklist for MIPS 2020 for optometrists without wasting any more time.

No Rules Change for Eligibility/ Opt-In Determinations

Not all optometrists are allowed to participate and earn incentives and bonuses from CMS for MIPS 2020 reporting. Clinicians have to check their eligibility status to get reimbursement for Medicare Part B services.

It is to be noted that there are no changes in eligibility criteria or the ability to opt-in to the program and are the same as in MIPS 2019.

Factors to Keep in Mind While Checking Eligibility

MIPS participation is optional for many optometrists. However, getting reimbursements for Medicare Part B services can uplift your finances. Even if you’re not eligible, it is important to understand its requirements.  

Once understood, you can make informed decisions for the future and generate better outcomes for your practice. There are quite a few submission methods; however, the best option is to consult a MIPS Qualified Registry because they take up the entire administrative burden easily.

Performance Threshold Changes

The final score to avoid a penalty in QPP MIPS 2020 goes up in 2020. Now, optometrists and physicians, in general, need to score 45 points to earn financial benefits. Furthermore, the score has to be at least 85 points to qualify for a bonus pool.

Payment Adjustment Factor Goes Up

Although the program’s expectations and criteria are strict, it is a great opportunity for physicians to understand the basics of QPP MIPS. Essentially, the program is about improving the quality of healthcare through value-driven measures. 

The payment adjustments for MIPS 2020 participation is up to +/- 9%. Having realistic considerations of external factors, successful clinicians can receive rewards of up to 6.25%.

Secure Health Information Exchange with Promoting Interoperability

If you have access to Electronic Health Information exchange, it accounts for up to 50% of the score of the Promoting Interoperability (PI) performance category. Therefore, investing in a digital system is an investment in the future. 

For example, the direct messaging protocol is a smart element that enhances quality patient support services. Many EHR vendors have already embedded this facility into their systems. Nevertheless, CMS demands it to be secure following HIPAA Compliance. 

Deliver PHR/Portal Credentials to the Patients for Positive Outcomes 

The performance category Promoting Interoperability is motivated by the empowerment of patients in their health information. The more access patients have to their data, the more exclusive outcomes can be generated to improve quality care for MIPS. 

It doesn’t matter if your patient doesn’t use this facility, as long as the facility is there for patients, you can achieve a higher score. It’s a win-win situation anyway. 

The measure having 40% of the total score cannot be taken lightly. Therefore, a solid secure internal system must be in place to provide easy access to medical records for patients to view and review.

Data completeness Requirement in Quality Goes Up

MIPS 2019 asked physicians to report at least 60% of the data for treated patients, but MIPS 2020 demands higher performance. Henceforth, you have to report quality measures for at least 70% of the applicable patients. 

In simple terms, if you treat 100 glaucoma patients in 2020, you have to report at least 70 patients with data having the same reported measure. In case of lesser information or with loosely reported data, CMS will not reward due credit, and you can receive the lowest possible score due to the unreliability of data.

Report Only the Specialty-Specific Improvement Activities

Improvement Activities (IA) include over 100 measures to choose from and report, and when we look deep into them, we see that most of the measures are already in practice. You need to report data for at least 90 consecutive days to get credit from CMS.

It is important to just review all the possible measures at the beginning of MIPS 2020 and plan accordingly. You can also search the keyword related measurers here –

Changes for Groups Attesting to Improvement Activities (IA)

Even when only one doctor from a group performed an Improvement Activity (IA) in 2019, the whole group gets rewards for the rendered service. This notion is not true for 2020.

Ordinarily, at least 50% of the clinicians in a group have to perform an activity to get a reward.

For instance, 7 out of 14 clinicians in a group have to perform the same activity during MIPS 2020 for a valid attestation.

Having said that, there is time flexibility for the performance period, which means, optometrists can perform an activity at any time of the year. Moreover, they don’t have to start or end the activity at the same time.


All of these factors seem burdensome to handle alone by the optometrists. Thus having a partner side by side is feasible for a successful MIPS 2020 data submission. That’s why is here to help. Contact us to start with MIPS Quality reports in a few easy steps.


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