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 for 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. The CMS Innovation Center (CMMI) develops and tests new healthcare payment and service delivery models, and the QPP is one such model. The CMMI’s models are alternative payment models (APMs) which reward health care providers for delivering high-quality and cost-efficient care.
The QPP offers two main reimbursement/participation tracks for physicians under Medicare Part B, with an optional track starting 2023:
Track 1: The Merit-based Incentive Payment System (MIPS)
Track 2: Advanced Alternative Payment Models (APMs)
Track 3: MIPS Value Pathways (MVPs) - Optional track beginning the 2023 performance year
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. HCMS has created a MIPS Step-By-Step Guide which includes information on how each category is scored, along with step-by-step details on how to report each MIPS category for the performance year (PY).
QPP Updates and Deadlines
- January 1, 2023 - PY 2020 payment adjustments go into effect and PY 2023 collection period begins.
- January 3, 2023 - PY 2022 submission window opens.
- March 1, 2023 - For PY 2022 measures submitted via claims, all claims must be processed by Novitas by this date.
- March 31, 2023 - PY 2022 submission window closes (Note: MIPS registries typically have an earlier deadline).
- April 3, 2023 - PY 2023 registration begins for Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey. Also, registration opens for MIPS Value Pathways (MVPs)
- Spring/Summer 2023 - PY 2023 Quality payment program exception application window opens.
- June 30, 2023 - Deadline for PY 2023 Registration for CAHPS for MIPS Survey.
- July 2023
- PY 2022 performance feedback, including MIPS final score and payment adjustment information
- PY 2022 targeted review opens
- PY 2023 Qualifying Participant (QP) determinations and MIPS APM participation information becomes available on the Quality Payment Program Participation Status Tool (March 31 APM Snapshot date)
- August/September 2023 - PY 2022 Targeted Review closes 60 days after the release of your payment adjustment information.
- October 2023 - PY 2023 QP determinations and MIPS APM participation information becomes available on the Quality Payment Program Participation Status Tool (June 30 APM Snapshot date).
- October 3, 2023 - PY 2023 last day to start a 90-day performance period for promoting interoperability and improvement activities.
- December 2023 - PY 2023 MIPS eligibility finalized.
- December 31, 2023
- PY 2023 collection period ends
- PY 2023 QPP exception applications window closes
- CY 2023 PFS Final Rule QPP Overview (QPP) (scroll to bottom of page for link)- Fact sheet on 2023 QPP program, comparison table, FAQs, and overview.
- CY 2023 PFS Final Rule Summary (AMA) - included is an executive summary and additional analyzations, made by AMA, of select provisions finalized in the rule.
- QPP Timeline and Important Deadlines
- QPP Resource Library - fact sheets, quick guides, video library for APMs and MIPS
- Physicians Advocacy Institute QPP Resource Center - for more information on navigating the QPP, MIPS pathway, video library, FAQs, QPP updates
- TMA QPP Resource Center - webinars, contacts, services, news, advocacy, timeline, important deadlines