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 Exemption Applications Now Available - 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. Physicians/groups have until Dec. 31, 2020 to complete the hardship application. Find additional information and application instructions on the 2020 Exception Application Fact Sheet
  • 2019 MIPS Targeted Review - If you believe an error has been made in your MIPS payment adjustment calculation, you can request a targeted review until Oct. 5.
  • 2019 MIPS Feedback Now Available- 2019 QPP final performance feedback, which includes your overall MIPS score and 2021 Medicare payment adjustment (bonus or cut) worth up to 7%, is available via the QPP portal. Physicians who did not submit any 2019 MIPS data or who filed an application for an exception due to COVID-19 should not receive a 2021 payment cut.
  • Check Your MIPS Eligibility - Check the QPP Participation Status Tool to view your MIPS eligibility status for the 2020  performance period.  Enter your NPI and select the appropriate year to find out if you need to participate.
  • 2020 MIPS Measure Changes - Although you will soon begin reporting your 2019 MIPS data it is important to be aware of possible changes to your selected MIPS measures for the 2020 performance year. The Quality category requires a full years worth of data in 2020 so it is important to begin collecting data now. Review our 2020 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.