Quality Payment Program

Established through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Quality Payment Program (QPP) is comprised of two tracks:  Merit-based Incentive Program (MIPS) and Advanced Alternative Payment Models (APMs).

What is the Quality Payment Program?

Merit-based Incentive Payment System (MIPS)

The Merit-based Incentive Payment System (MIPS) is one track in the Medicare Quality Payment Program (QPP).

 

Most physicians and other clinicians are eligible to participate in MIPS, although some exclusions do apply.

To check if you’re eligible to participate in MIPS in 2019, enter your 10-digit National Provider Identifier in the Quality Payment Program Participation Status Tool on the Quality Payment Program website.

MIPS works on a two-year cycle. Performance year 2019 (PY2019) affects Medicare payments in calendar year 2021 (CY 2021).  

If you submit 2019 data for MIPS by March 31, 2020, you’ll receive a positive, negative, or neutral payment adjustment in 2021, which will be based on your MIPS final score.

The maximum payment adjustments for 2021 are +/- 7 percent. In 2019 you can avoid a negative payment adjustment by achieving a MIPS final score of at least 15 points.

Maximum payment adjustments climb to +/- 9 percent beginning in 2022 (based on MIPS performance in 2020).  

Performance in MIPS is measured through the data physicians and other eligible clinicians report in four areas: Quality, Cost, Improvement Activities, and Promoting Interoperability. The performance categories have different “weights” and are added together to give you a MIPS final score.

  • Quality – 45 percent
  • Promoting Interoperability – 25 percent
  • Improvement Activities – 15 percent
  • Cost – 15 percent

You can participate in MIPS as an individual, group, or both. Learn more by visiting the Medicare Quality Payment Program website.

If you submit 2019 data for MIPS by March 31, 2020, you’ll receive a positive, negative or neutral payment adjustment in 2021, which will be based on your MIPS final score.

 
2019 QUALITY PERFORMANCE CATEGORY

To report on the Quality performance category, MIPS participants must collect quality measure data for the 12-month performance period (Jan. 1 – Dec. 31, 2019).

Explore 2019 quality measures on the Medicare Quality Payment Program website.

The amount of data that must be collected and submitted depends on the collection (measure) type.

Explore 2019 quality measure reporting requirements on the Medicare Quality Payment Program website.

 
2019 PROMOTING INTEROPERABILITY PERFORMANCE CATEGORY

To report on the Promoting Interoperability performance category, MIPS participants must submit collected data for certain measures from each of four objectives (unless an exclusion is claimed) for 90 continuous days or more during 2019.

Explore 2019 promoting interoperability objectives and measures on the Medicare Quality Payment Program website.

Use of 2015 Edition CEHRT is required for participation in this performance category.

Explore 2019 promoting interoperability reporting requirements on the Medicare Quality Payment Program website.

 
2019 IMPROVEMENT ACTIVITIES PERFORMANCE CATEGORY

To report on the Improvement Activities performance category, MIPS participants must submit a combination of high- and medium-weighted activities. Each activity must be performed for 90 continuous days or more during 2019.

AGA’s Guideline App in both iTunes and Google Play is a CMS-approved Improvement Activity available.  Using the App for 90 continuous data or more in 2019 will meet requirements of IA_PSPA-8.   

Explore other 2019 improvement activities on the Medicare Quality Payment Program website.

The number of high- and medium-weighted activities needed to achieve full credit in the Improvement Activities performance category depends on whether you have certain special statuses and other factors.

Explore 2019 improvement activities reporting requirements on the Medicare Quality Payment Program website.

 
2019 COST PERFORMANCE CATEGORY

There are no reporting requirements for the Cost performance category. Cost measures are calculated using Medicare claims data.

One episode-based cost measure (EBCM), screening/surveillance colonoscopy, relates to gastroenterology. The Screening/Surveillance Colonoscopy cost measure is meant to apply to clinicians who perform screening/surveillance colonoscopy procedures during the performance year. The measure evaluates a clinician’s risk-adjusted cost for the episode group by averaging it across all episodes attributed to the clinician.

Explore the detailed measure specifications for the screening/surveillance colonoscopy cost measure.

MIPS participants may also be measured on other episode-based cost measures or on measures evaluating Total per Capita Cost and Medicare Spending per Beneficiary.

Explore other 2019 cost measures on the Quality Payment Program website.

Advanced alternative payment models (advanced APMS)

Advanced alternative payment models (APMs) are a track of the Quality Payment Program that offer a 5 percent incentive for achieving threshold levels of payments or patients through Advanced APMs. If you achieve these thresholds, you become a Qualifying APM Participant (QP) and you are excluded from the MIPS reporting requirements and payment adjustment.

Explore 2019 requirements for becoming a Qualifying APM Participant on the Quality Payment Program website.

INTRODUCTION TO ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)

There are also other types of APMs. 

Explore other types of APMs, including MIPS APMS and All-Payer Advanced APMs on the Quality Payment Program website.