8 Ways to Know if You Should Participate in the Quality Payment Program
May 8, 2017
You may have heard the Centers for Medicare & Medicaid Services (CMS) is reviewing claims and letting practices know which clinicians should take part in the Merit-based Incentive Payment System (MIPS). MIPS is an important part of the new Quality Payment Program.
The Quality Payment Program works to make Medicare better by keeping patients at the center of health care while paying clinicians based on their performance. It replaces the Sustainable Growth Rate formula, which threatened clinicians participating in Medicare with potential payment cuts for 13 years. This program combines and streamlines many existing Medicare quality programs. It also gives new ways to improve care delivery by supporting and rewarding clinicians who
- find new ways to engage patients, families and caregivers;
- improve care coordination and population health management.
During this first year as we move to the Quality Payment Program, CMS is committed to working hard with clinicians to make the reporting and participation process easier. It is a CMS priority to further reduce burdensome requirements so clinicians can deliver the best possible care to patients.
Here are eight ways to know whether you are included in the Quality Payment Program:
- Visit qpp.cms.gov, click on the MIPS Participation Look-up Tool and use your National Provider Identifier (NPI) to check your status. Also, you may have recently gotten a letter from your Medicare Administrative Contractor (MAC) that tells if you are included in MIPS. Your practice should have received a letter that includes the MIPS participation status of each clinician associated with the practice’s Taxpayer Identification Number (TIN).
- You are included if you are a:
- Physician (includes doctors of medicine, doctors of osteopathy (including osteopathic practitioners), doctors of dental surgery, doctors of dental medicine, doctors of podiatric medicine, doctors of optometry, and chiropractors)
- Physician assistant
- Nurse practitioner
- Clinical nurse specialist
- Certified registered nurse anesthetist
- A group including such clinicians
- You are a MIPS eligible clinician that bills $30,000 or more in Medicare Part B allowed charges a year AND provides care to more than 100 Part B-enrolled Medicare beneficiaries a year. If you did both and you are part of MIPS for the 2017 transition year. In other words, you go beyond the “low-volume threshold.” CMS determined billing and patient volume by using claims data from September 1, 2015 through August 31, 2016. CMS will identify additional low-volume clinicians using claims data from September 1, 2016 through August 31, 2017.
- You are not new to Medicare in 2017. If you are new in 2017, you are not part of MIPS.
- Your practice tells you the group you are a part of is participating. Each practice should let its clinicians know its MIPS status. If you practice under more than one TIN, you will hear about your status for each TIN. Your status can be different across TINs. For example, you might be part of two practices with different TINs. Your Medicare billing and patient count might be more than the low-volume threshold at one practice, but not at the other practice.
- Your practice chooses to participate in MIPS as a group. If your group does choose to participate, you will be assessed and scored as a group.
- You did not participate sufficiently in Advanced Alternative Payment Models (APMs) and become a Qualifying APM Participant (QP). If you did, you are exempt from participating in MIPS. If you are in an Advanced APM and become a Partial QP, you may choose whether to report on MIPS measures and activities, be scored using the APM scoring standard and be subject to a MIPS payment adjustment. Partial QPs can choose not to participate in MIPS, but they still have to meet the participation requirements of their APMs.
- You want to participate. Even if you do not have to participate in the MIPS program you can still choose to participate. If you do, you will not be subject to MIPS payment adjustments.
The Quality Payment Program has free resources to help.
- Visit the official CMS website at qpp.cms.gov
- Email qpp@cms.hhs.gov
- Call 1-866-288-8292 (toll-free)
TTY 1-877-715-6222
You can also contact Mountain-Pacific Quality Health’s help desk for one-on-one, direct assistance by emailing QualityPaymentHelp@mpqhf.org. Mountain-Pacific has MIPS experts on staff to help you develop your 2017 action plan and find answers for your tough questions.
Leave a reply, ask a question or share information using the “Leave a Reply” section below, or email Sharon Phelps directly with your questions or comments.
Other Resource Links
CMS QPP Website
HTS MIPS Services
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