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 – 2018 Performance Year

MIPS Year 2 Highlights:

  • Low-volume threshold for Year 2 has increased to less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries
  • Performance threshold has been raised to 15 points in Year 2 (from 3 points in the transition year)
  • Including the Cost performance category at 10% of your total MIPS final score, where Quality will be 50%, Advancing Care Information are 25% and Improvement Activities are 15%
  • For Year 2, the performance period for Quality measures has increased to a minimum 12 month performance period (No change for ACI, Improvement Activities and Cost performance periods)
  • Use either 2014 Edition and/or 2015 Certified Electronic Health Record Technology (CEHRT) in Year 2
    • 10% bonus for using only 2015 CEHRT
  • Up to 5 bonus points added to final score in Year 2 for complex patients
  • 5 bonus points added to final score in Year 2 for small practices
  • Automatically reweighting all 3 categories to 0% of the final score for clinicians impacted by hurricanes Irma, Harvey and Maria and other natural disasters

Virtual Groups:

Virtual Groups is a new participation option for year 2. A virtual group consists of 2 or more TINs including solo providers or groups of 10 or less ECs who work together, no matter specialty or location, to participate in MIPS.

For the 2018 MIPS performance period, the election period for virtual groups to make an election is from October 11, 2017 to December 1, 2017.

Download the Virtual Groups Toolkit here: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/2018-Virtual-Groups-Toolkit.zip

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)