Quality Payment Program and MIPS Reporting 

About the Program

The Quality Payment Program (QPP) is a CMS initiative to support clinicians who bill Medicare Part B in the transition from fee-for-service to value-based payments. It offers two tracks: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).  Each track requires eligible clinicians to report on quality data and clinical activities.

MIPS Eligibility

For eligible professionals providing services which get paid under or based on the Medicare Physician Fee Schedule (PFS), those services are eligible for MIPS incentive payments and/or payment adjustments. Eligible clinicians include:

  • Medicare Physicians (Doctors of medicine, osteopathy, dental surgery/dental medicine, podiatry, and optometry; chiropractors)
  • Physician Assistants
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists (and Anesthesiologist Assistants)

Any clinician group that includes one of the professionals listed above can report as a group. If you bill as a group, you should report as a group.

Note: Eligible Clinicians that meet the following conditions will be excused from participating in MIPS:

  • In first year participating in Medicare
  • Bill less than $30,000 Medicare Part B charges during 2017
  • Provide care for less than 100 Medicare patients per year 
  • Participate in an Advanced APM

To verify your MIPS participation status and obligations, use the following CMS tool: https://qpp.cms.gov/learn/eligibility.

Merit-Based Incentive Payment System (MIPS)

MIPS is the result of CMS’s efforts to reduce the quality reporting burden for clinicians. It has 4 different performance categories:  

  1. Advancing Care Information (ACI) - previously Meaningful Use (MU)
  2. Improvement Activities (IA) - New category
  3. Quality - Previously PQRS
  4. Cost - Previously Value-based Modifier (VM)

Based on the 2017 performance score of eligible clinicians or practices, CMS will apply a payment adjustment from -4 % to a +4% to all their Medicare Part B billing in 2019. Any qualified eligible clinician or practice that does not participate will automatically receive a -4 % payment adjustment.

Since 2017 is a transition year, eligible clinicians and practices can pick their pace and determine what level of data they want to report and for what time over the performance period. The more data and the longer reporting period represented, the greater opportunity to achieve the full +4% upward adjustment and potential for a bonus payment.

How to report:

  1. Decide how you will report: as an Individual or a Group
  2. Confirm your EHR’s version number and CEHRT’s status
  3. Select the measures and/or improvement activities you want to report
  4. Select your registry for reporting
  5. Pick your pace: Determine your level of engagement for MIPS reporting

Alternative Payment Models (APMs)

Under the QPP initiative, CMS also offers APMs, a second path for value-based payment structures that allow participating eligible clinicians to earn incentive payments. Incentives focus on eligible clinicians who deliver high-quality and cost-efficient care. Detailed information can be found here: https://qpp.cms.gov/learn/apms