Medicare Quality Payment Program

What is the Medicare Quality Payment Program?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) developed the ground work a new program known as the Quality Payment Program (QPP), under which clinicians have the opportunity to earn bonuses, or face penalties in the form of positive, neutral, or negative adjustments based on their performance in quality and cost measures. On Nov. 4, 2016, CMS finalized its policy implementing the Medicare Quality Payment Program (QPP). The QPP shifts physician reimbursements from the traditional fee-for-service model to a value-based payment model. While this may seem like a new program, it is not unfamiliar from past CMS value-based programs such as PQRS, Meaningful Use, and the Value-Based Modifier program, that provided physicians with incentives and bonuses payments for reporting quality and cost data on their patients.

The QPP offers two reimbursement/participation tracks for physicians under Medicare Part B:  

Track 1: The Merit-based Incentive Payment System (MIPS)
Track 2: Advanced Alternative Payment Models (APMs)

Along with this finalized rule, CMS has launched their Quality Payment Program website which will explain the new program and help clinicians easily identify the measures most meaningful to their practice or specialty.  

QPP Updates and Deadlines

  • 2020 MIPS Automatic Relief and Extreme and Uncontrollable Circumstances Hardship Application: Physicians now have the option to opt-out completely or partially from the 2020 MIPS program by completing a hardship exemption application and indicating it is due to the COVID-19 Public Health Emergency (PHE) and be held harmless from a 2022 payment adjustment. CMS is automatically applying the extreme and uncontrollable circumstances policy. APMs and Groups have until March 31, 2021 to submit a hardship application. For information and resources on how this affects your practice, refer to the Policy Fact Sheet and the TMA Article.
  • January 1 - March 31, 2021 - MIPS Submission window for 2020 PY
  • April 1 - June 30, 2021 - Registration for CMS Web Interface and CAHPS for MIPS Survey.
  • July 2021 - 2020 Performance Feedback available - This includes your overall MIPS score and payment adjustment via the QPP portal. 
  • July 2021 - Target Review Opens -  If you believe an error has been made in your MIPS payment adjustment calculation, you can request a targeted review. This opens once your payment adjustment information is available.
  • August/September 2021 - Targeted Review Closes 60 days after the release of your payment adjustment information.
  • January 1, 2022 - PY 2020 Payment Adjustments go into effect.
  • Check Your MIPS Eligibility - Check the QPP Participation Status Tool to view your MIPS eligibility status for the performance period.  Enter your NPI and select the appropriate year to find out if you need to participate.
  • MIPS Measure Changes - It is important to be aware of possible changes to your selected MIPS measures for the 2021 performance year. The Quality category requires a full years worth of data in 2021, so it is important to begin collecting data now. Review our 2021 Measure Changes chart to identify if any of your current measures have been deleted or modified so you may make the appropriate changes in time.

QPP Resources