Quality Payment Program (QPP)

Visit the Quality Payment Program (QPP) website at http://qpp.cms.gov.

***Please note, all information on this page is SUBJECT TO CHANGES by CMS. ***


The Quality Payment Program started on January 1, 2017.

The first payment adjustments based on 2017 performance go into effect on January 1, 2019 and your 2019 Medicare payments will be adjusted up, down, or not at all. The amount of your payment adjustment will vary depending on the data submitted to CMS. For each performance year (PY) the payments adjustments to your Medicare payments are as follows:

  • 2017 PY +/-4%
  • 2018 PY +/- 5%
  • 2019 PY +/- 7%
  • 2020 PY +/- 9%

Quality Payment Program Year 3 – 2019

Final Rule Highlights:

  • To be excluded from MIPS for 2019 the low-volume threshold must be less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B enrolled beneficiaries or provide less than 200 covered professional services to Part B patients (NEW for 2019)
  • Cost performance category is 15% of your total MIPS final score, Quality is 45%, Promoting Interoperability (PI) is 25% and Improvement Activities is 15%
  • Performance Year for 2019 is January – December 31, 2019, but not all categories require 12 months of data collection. Payment adjustments based on this performance period will be made in 2021.
    • Quality: 12 Months
    • Cost: 12 months
    • Improvement Activities: continuous 90 days
    • Promoting Interoperability: continuous 90 days

 

Resources:

For more details regarding MIPS and APMs please visit: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Resource-library.html

Contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292 (TTY: 1-877-715-6222).

Click on the links below to view more information on the individual programs:

Merit-based Incentive Payment System (MIPS) Advanced Alternate Payment Models (APMs)