The Quality Payment Program Decoded!

The Department of Health and Human Services (HHS) released the final rule of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), with comment period implementing the Quality Payment Program (QPP), which is a part of MACRA. QPP improves Medicare by putting the focus on quality of care that provides better treatment for patients. QPP incorporates new tools and resources and enables you to give your patients the best and highest-value care. The Program focuses on moving the payment system to reward patient-centered care.

The Quality Payment Program is a major step to improve care across the entire health care delivery system and it will reform Medicare payments for more than 600,000 clinicians across the country. You can choose how you want to participate in QPP on the basis of your specialty, practice size, patient population, or location. You can choose from two tracks in the program, which are:

Merit-based Incentive Payment System (MIPS) Advanced Alternative Payment Models (APMs)
Traditional Medicare participation, where you earn a performance-based payment adjustment. You might earn a Medicare incentive payment for participation.

Who is involved with QPP?

You are eligible for participation in the MIPS track of the Program if:

  • You provide care to more than 100 Medicare patients per year,
  • Bill more than $30,000 to Medicare, and
  • You are a physician, physician assistant, clinical nurse specialist, nurse practitioner, or a certified registered nurse anesthetist.

However, if 2017 is your first participating year in Medicare, then you need not participate in the Program in 2017.

QPP Timeline

  • If you are ready, you can participate in the program from January 1, 2017, and start collecting your performance data.
  • If you are not ready to participate in January 2017, you can choose to start anytime between January 1, 2017, and October 2, 2017.
  • However, irrespective of when you choose to start, you will be required to send in your performance data by March 31, 2018.
  • The first performance-based payment adjustments will come into effect on January 1, 2019.

Impact on Your Medicare Payments

Your Medicare payments will be adjusted in 2019 depending on the track of the program you choose and the data you submit by March 31, 2018.

Participating in MIPS

The payment adjustment that you earn will depend on how much data you submit and your quality results.

No Participation If you do not send in any data for 2017, you will receive a negative payment adjustment of 4%.
Partial Participation Submitting 90 days’ data, for 2017, to Medicare, might help you earn a neutral or a small positive payment adjustment.
Full Participation Submitting a full year data, for 2017, to Medicare, might help you earn a moderate positive payment adjustment.

Participating in Advanced APMs:

If you see 20% of your Medicare patients through an Advanced APM in 2017, or receive 25% of Medicare covered professional services You will earn a Medicare Incentive Payment of 5% in 2019.

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