What is the Quality payment program?

The Quality Payment Program implements provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and improves Medicare payments to focus on care quality for patients.









Who Participates in the Quality Payment Program?

Who's In

The eligible clinicians must participate in the QPP in either MIPS or Avanced APMs.

  • Physician
  • Physician Assistant
  • Nurse Practitioner
  • Clinical Nurse Specialist
  • Certified Registed Nurse Anesthetist

Who's Excluded

The following providers are excluded from the QPP in 2017

  • Providers in their first year of Medicaid in 2017
  • Providers who see fewer than 100 Medicare patients each year.
  • Providers who bill $30,000 or less in annual Medicare claims

How to submit data

MIPS or Advanced APMS

With MIPS you can select your measures and determine how many points are needed for successful reporting. Your EHR must be certified in order to participate in MIPS. This will also determine the set of measures that you are able to use. Medicare's reimbursements to providers will be based on how they perform across the following three categories:


  • Quality Measures   60% of MIPS SCORE
  • Advancing Care Information 25% of MIPS SCORE
  • Improvement Activities 15% of MIPS SCORE

Reporting

If you're exempt from MIPS with the first review, you won't need to do anything else for MIPS this year. If you are included in MIPS, you may be exempt with the second review of eligibility determinations at the end of 2017. Below you will find various links to the CMS.gov website to help guide you in submitting data.



Scoring and payment adjustments

If you decide to participate in an Advanced APM, you may earn an incentive payment through Medicare Part B. If you decide to participate in MIPS, you will earn a performance-based payment adjustment – up, down, or not at all – based on the data that you submit. In either track, the first payment adjustments based on performance in 2017 go into effect on January 1, 2019.