The Centers for Medicare and Medicaid Services (CMS) has developed the Quality Payment Program (QPP) for clinicians who bill Medicare Part B. QPP has two tracks:
• The Merit-based Incentive Payment System (MIPS)
• Advanced Alternative Payment Models (APMs)
Eligible clinicians, who participate in MIPS 2018 (QPP Year 2) and exceed the performance threshold (15 points for 2018), will be eligible for a payment adjustment up to +5% in 2020. Eligible clinicians who do not participate will receive a -5% payment adjustment in 2020. Eligible clinicians’ MIPS 2018 performance will be publicly available on Physician Compare.
An APM is a payment approach that trends away from the fee-for-service model and toward value-based-care. An Advanced APM takes this model one step further and requires practices to take on financial risk related to their patient’s outcomes.
CMS released the proposed rule for QPP Year 3 (2019) in July 2018 and the QPP Year 3 (2019) Final Rule was released November 1, 2018. The QPP Year 3 (2019) Final Rule can be reviewed on the CMS Resources Library Contact your QIA or send an email to firstname.lastname@example.org.
Overview of Transition Year 2018 MIPS program and eligibility requirements.
SNE-PTN recommends subscribing to CMS QPP Listserve on the bottom of the CMS QPP Home Page (Subscribe to Updates).