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 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, 2022 - PY 2020 payment adjustments go into effect and PY 2022 collection period begins.
- January 3, 2022 - PY 2021 submission window opens.
- February 15, 2022 - QPP SURS Initiative ends but the website content is still available.
- March 1, 2022 - Deadline for PY 2021 Quality Performance Category submission for claims.
- March 31, 2022 - PY 2021 submission window closes (Note: MIPS registries typically have an earlier deadline).
- April 1, 2022 - PY 2022 registration begins for Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey (if you choose to report via the CMS Web Interface or administer the CAHPS for MIPS Survey).
- Spring/Summer 2022 - PY 2022 Quality payment program exception application window opens.
- June 30, 2022 - Deadline for PY 2022 Registration for CAHPS for MIPS Survey and CMS Web Interface.
- July 2022
- PY 2021 performance feedback, including MIPS final score and payment adjustment information
- PY 2021 targeted review opens
- PY 2022 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 2022 - PY 2021 Targeted Review closes 60 days after the release of your payment adjustment information.
- October 2022 - PY 2022 QP determinations and MIPS APM participation information becomes available on the Quality Payment Program Participation Status Tool (June 30 APM Snapshot date).
- October 3, 2022 - PY 2022 last day to start a 90-day performance period for promoting interoperability and improvement activities.
- December 2022 - PY 2022 MIPS eligibility finalized.
- December 31, 2022
- PY 2022 collection period ends
- PY 2022 QPP exception applications window closes
- January 1, 2023 - PY 2021 payment adjustments go into effect.
- January 3, 2023 - PY 2022 submission window opens.
- March 31, 2023 - PY 2022 submission window closes.
- Summer 2023
- PY 2022 Performance Feedback (including payment adjustment information) becomes available.
- PY 2022 Targeted Review opens once your payment adjustment information becomes available.
- August/September 2023 - PY 2022 Targeted Review closes 60 days after the release of your payment adjustment information.
- January 1, 2024 - PY 2022 payment adjustments go into effect and continues through December 31, 2024
- CY 2022 PFS Final Rule QPP Overview (QPP) - fact sheet over the direction of the QPP program and details surrounding all reporting pathways: MVPs, APP, and traditional MIPS.
- CY 2022 PFS Final Rule QPP Comparison Table (QPP) - a comparison table showing the changes to the existing QPP policy, given the CY 2022 QPP finalized policy.
- CY 2022 PFS Final Rule Summary (AMA) - included is an executive summary and additional analyzations, made by AMA, of select provisions finalized in the rule.
- Ask The Expert: 2022 Medicare Update (TMA) -Ask the Expert PowerPoint slides including the latest updates on the 2022 Medicare update. Podcast Coming Soon on the TMA's Ask The Expert page.
- 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