CMS QUALITY PAYMENT PROGRAM
The Medicare Access and CHIP Reauthorization Act (MACRA) repealed the Sustainable Growth Rate (SGR) formula for physician payments and introduced a new Medicare value-based reimbursement system. The new system, the Medicare Quality Payment Program (QPP), has two tracks that providers will choose from, the Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS).
Providers who are subject to the QPP include physicians, physician assistants (PAs), nurse practitioners (NPs), clinical nurse specialists (CNSs), and certified registered nurse anesthetists (CRNAs). Providers that are new to Medicare, and those that meet a low-volume threshold are exempt from MIPS this year as are certain providers participating in an APM.
Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released an online lookup tool through which providers can determine their participation status in the Merit-based Incentive Payment System (MIPS) by entering their 10-digit National Provider Identifier (NPI) on the QPP website: https://qpp.cms.gov/learn/eligibility. Through this interactive tool providers can determine if they need to submit data to MIPS.
CMS maintains a robust QPP website that contains detailed information on both MIPS and the APM arm of the QPP including archived Webinars, a sample MIPS Participation Status Letter and numerous documents on the MIPS program.
In addition, CMS is providing free assistance to practices to help with MIPS reporting. For small practices with 15 or fewer clinicians, local experienced organizations will provide free help selecting and reporting measures and activities for each MIPS performance category, engaging in continuous quality improvement, optimizing their health information technology (HIT), and evaluating options for joining an Advanced Alternative Payment Model (APM). For larger practices (those with more than 15 clinicians), CMS has developed 14 Quality Innovation Networks – Quality Improvement Organizations (QIN-QIOs) to provide direct technical support for providers and to facilitate sharing best practices for quality improvement.
CMS QPP RESOURCES
CMS QPP Website:
Assistance for small practices:
Assistance for larger practices:
QPP Technical Assistance Resource Guide:
ASCO MACRA Resources
ASCO is conducting a series of webinars to help practices prepare for successful quality reporting under the QPP. They also have archived recordings and slide decks from their “Are you Ready for MACRA?” Education Series. You can access all of the ASCO MACRA QPP resources here: http://www.asco.org/practice-guidelines/billing-coding-reporting/macra-quality-payment-program/macra-webinar-series.