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. You can choose how you want to participate based on your Practice size, Specialty, Location, or Patient population.

Quality Payment Program

Why is the Quality Payment Program important?

The Quality Payment Program combines and replaces three separate Medicare related programs with a single system where Medicare Clinicians have the opportunity to be paid more for doing what they do best – making their patients safer and healthier. The vast majority of measures in the program are Clinician-initiated, ensuring that we are rewarding what matters most to Clinicians and their patients.

Importance of Quality Payment Program

Merit Based Incentive Payment System
divided in to 4 categories

QUALITY

QUALITY

IMPROVEMENT ACTIVITIES

IMPROVEMENT ACTIVITIES

ADVANCING CARE INFORMATION

ADVANCING CARE INFORMATION

COST

COST

Replaces PQRS

New Category

Replaces the Medicare EHR Incentive Program also known as Meaningful use

Replaces the Value-Based Modifier

60%

of Total MIPS Composite Score

25%

of Total MIPS Composite Score

15%

of Total MIPS Composite Score

0%

of Total MIPS Composite Score

Merit Based Incentive Payment System
divided in to 4 categories

QUALITY

QUALITY

Replaces PQRS

60%

of Total MIPS Composite Score

IMPROVEMENT ACTIVITIES

IMPROVEMENT ACTIVITIES

New Category

25%

of Total MIPS Composite Score

ADVANCING CARE INFORMATION

ADVANCING CARE INFORMATION

Replaces the Medicare EHR Incentive Program also known as Meaningful use

15%

of Total MIPS Composite Score

COST

COST

Replaces the Value-Based Modifier

0%

of Total MIPS Composite Score

Who Is eligible to participate in MIPS and
subject to payment adjustments?

You are a part of the MIPS track of Quality Payment Program
if you bill Medicare Part B more than $30,000 as an Individual Clinician and provide care for more than 100 Medicare Part B patients during the determination period and are a:

PhysicianPhysician
Assistant
Nurse
Practitioner
Clinical Nurse
Specialist
Certified Registered Nurse Anesthetist

Eligible clinican can participate in MIPS as an Individual or Group

You do not participate in MIPS if you are :

In your first year of enrollment as a Medicare provider


Below the low-volume threshold: care for 100 or fewer Medicare beneficiaries or have $30,000 or less in Medicare part B allowed charges in a year.


Above the threshold for significantly participating in an Advanced APM

When Does it Start?

You get to pick your pace for the Quality Payment Program. You can choose to start anytime between January 1 and October 2, 2017. Whenever you choose to start, you will need to send in your performance data by March 31, 2018.

Quality Program Start Dates

How will the Quality Payment Program affect my Payments?

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.


The first payment adjustments based on performance in 2017 go into effect on January 1, 2019.

Payments

What is Pick your pace?

If you choose the MIPS path of the Quality Payment Program, you have three options.

Participate

The MIPS payment adjustment is based on the data submitted. The best way to get the maximum MIPS payment adjustment is to participate full year. By participating the full year, you have the most measures to pick from to submit, more reliable data submissions, and the ability to get bonus points.


But if you only report 90 days, you could still earn the maximum adjustment—there is nothing built into the program that automatically gives a reporter a lower score for 90-day reporting.


Pick the pace that’s best suited for your Practice.