Resources
Quality Payment Program
The well-being of your patients is your greatest concern; ours is to make sure you remain financially viable so you can deliver the care they deserve.
Mountain-Pacific can help your practice take an integrated approach to the Quality Payment Program. We know the rules. We stay current on updates and clarifications. We avail ourselves of CMS learning opportunities and will ensure that you benefit from all we know. Below are some tools and resources to help you navigate the Quality Payment Program.
2020 MIPS Payment Adjustment Fact Sheet PDF
This CMS fact sheet reviews how the payment adjustment will be applied in 2020 based on your 2018 MIPS performance.
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2018 MIPS Performance Feedback and 2020 Payment Adjustment PDF
This CMS guide provides a comprehensive overview of the 2018 MIPS performance feedback available on the QPP portal. The MIPS performance feedback is unique to your practice’s TIN.
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2019 MIPS Complex Patient Bonus Fact Sheet PDF
This CMS fact sheet provides an overview of the Complex Patient Bonus, which is added to the MIPS final score based on the complexity of the patients treated.
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MIPS Value Pathways Diagram PDF
In the Proposed Rule for QPP in 2020, CMS outlined a proposal for a new program – the MPS Value Pathways, or MVPs. See an overview in this CMS diagram.
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2019 MIPS 101 Guide PDF
Questions about MIPS in 2019? This comprehensive guide from CMS provides a detailed overview of MIPS for 2019.
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Why Report MIPS? PDF
See this flyer for the benefits of reporting MIPS.
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2019 MIPS Eligibility Decision Tree PDF
This brief CMS resource helps clinicians determine if they are eligible to participate in the MIPS track of the QPP in the 2019 performance period.
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2019 MIPS Participation: MIPS Participation is as easy as 1-2-3! PDF
MIPS Participation is as easy as 1-2-3 with this information pamphlet from Comagine Health. Find out the first steps when getting started with MIPS. Successfully submitting data to the Merit Based Incentive Payments System (MIPS) in 2019 will help you avoid up to a -7% penalty, and or earn up to +7% adjustment on professional fees submitted onyour Part B Medicare claims in 2020.
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2019 MIPS Group Participation Guide PDF
This guide from CMS gives a comprehensive overview of group participation in MIPS, including eligibility, group registration for CMS Web Interface and CAHPS for MIPS Survey, data collection and submission for each MIPS performance category, and scoring and payment adjustments. Updated 8/14/19.
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Proposed 2020 Merit-based Incentive Payment System (MIPS) Changes Flyer PDF
See this flyer for a brief overview of the important proposed changes for MIPS eligible clinicians for 2020.
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QPP: Billing Office Information PDF
Get an overview of the QPP scoring system and evaluation/performance timeframe through 2022, as well as links to informative resources for your billing office with this informative one-page flyer from HealthInsight.
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QPP Performance Year 2019 Info Sheet PDF
For 2019 reporting, which determines your 2021 payment, CMS has set the performance threshold at 30 points. View this informative one-page document from HealthInsight to help understand how eligible clinicians can meet the performance threshold and avoid a payment penalty.
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MIPS Performance Year 2019 for Physical Therapists PDF
For 2019 reporting, which determines your 2021 payment, CMS has set the performance threshold at 30 points. View this informative one-page document from HealthInsight to help Physical Therapists understand how to meet the performance threshold and avoid a payment penalty.
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2019 MIPS Opt-In and Voluntary Reporting Policy Fact Sheet PDF
This comprehensive fact sheet from CMS provides detailed information on the new MIPS opt-in policy as well as the existing voluntary participation option, with a specific focus on the key differences between the two options as it relates to general participation, scoring, and payment adjustments.
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Steps to Success for MIPS 2019 PDF
A six step guide to reporting in the Merit-based Incentive Payment System (MIPS).
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No Cost Online MIPS Estimator Link
This comprehensive, accurate, easy-to-use, online tool is available at no cost to support clinicians and health care organizations to succeed in the MIPS. The Estimator from Stratis Health provides clinicians individualized, instant feedback about their MIPS status and accelerates planning for quality improvement. Access all of the information needed about MIPS in one place to prepare for reporting, self-assess current performance across the MIPS categories, determine how to make workflow changes to improve patient outcomes, and work towards improving your MIPS score to achieve the highest possible reimbursement.
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QPP Participation Status (MIPS and APM) Link
On this CMS webpage, clinicians can enter their 10-digit National Provider Identifier (NPI) number to receive their QPP Participation Status, which includes APM Participation as well as MIPS Participation information.
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2019 Merit-based Incentive Payment System Quick Start Guide PDF
This informative guide from CMS introduces qualified entities to the information they need to know to get started for MIPS in 2019.
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2019 MIPS Participation and Eligibility Fact Sheet PDF
This CMS fact sheet provides an overview of the eligibility criteria for participating in the Merit-based Incentive Payment System (MIPS) in 2019.
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2020 QPP Proposed Rule Overview Fact Sheet PDF
This CMS fact sheet provides a high-level comprehensive overview of the Quality Payment Program final policies for the 2019 performance year.
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Topped-Out Quality Measures in 2019 PDF
View this list from Quality Insights to see the topped-out measures for 2019. Quality measures are ‘topped-out’ when the measure performance is high, unvarying across the board, and meaningful distinctions and improvement in performance can no longer be made.
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MIPS 2019 MIPS Quality Measures Impacted by ICD-10 Updates PDF
This CMS resource lists the 2019 MIPS quality measures impacted by ICD-10 code updates effective October 1, 2019.
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MIPS 2019 Quality Measures by Submission Method PDF
The Quality category is worth 45% of the total MIPS score in 2019, but can change due to special statuses, exception applications, reweighting of other performance categories, or Alternative Payment Model (APM) participation. View this 2019 Measures list from Quality Insights.
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2019 Quality Data Validation Criteria PDF
Use this CMS resource to see what documentation is recommended to attest to the different activities listed in the 2019 Improvement Activities performance category.
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2019 MIPS Quality User Guide PDF
Download this comprehensive guide from CMS for details on how to participate in the Quality performance category of MIPS in 2019.
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Quality Fact Sheet PDF
This CMS fact sheet discusses the MIPS Quality performance category for 2019 and includes an overview of quality measures and how to collect and submit quality data.
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2019 Quality Measure Benchmarks Fact Sheet PDF
In program year 2019, a clinician or group can receive anywhere from 3 to 10 points for each MIPS measure (not including any bonus points) that meets the data completeness standards and case minimum requirements by comparing measure performance to established Benchmarks. Learn more about Quality benchmarks and how they can affect your MIPS score with this CMS factsheet.
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2019 QPP MIPS Clinical Quality Measures Single Source File – Measures 001 – 195 Excel
These spreadsheets from CMS are tools that eligible clinicians can use to search for common CPT codes, measure numbers, etc. within each individual registry measure for the 2017 Quality Payment Program (QPP). This may assist in identifying measures that may apply to your practice based on common codes that you may utilize when seeing beneficiaries. This spreadsheet is the Single Source File for Measures: 001 – 195.
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2019 QPP MIPS Clinical Quality Measures Single Source File – Measures 204 – 398 Excel
These spreadsheets from CMS are tools that eligible clinicians can use to search for common CPT codes, measure numbers, etc. within each individual registry measure for the 2017 Quality Payment Program (QPP). This may assist in identifying measures that may apply to your practice based on common codes that you may utilize when seeing beneficiaries. This spreadsheet is the Single Source File for Measures: 204 – 398.
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2019 QPP MIPS Clinical Quality Measures Single Source File – Measures 400 – 474 Excel
These spreadsheets from CMS are tools that eligible clinicians can use to search for common CPT codes, measure numbers, etc. within each individual registry measure for the 2017 Quality Payment Program (QPP). This may assist in identifying measures that may apply to your practice based on common codes that you may utilize when seeing beneficiaries. This spreadsheet is the Single Source File for Measures: 400 – 474.
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CMS Quality Payment Program – Quality Measure Requirements Page Link
This performance category measures health care processes, outcomes, and patient care experiences. Use this interactive CMS website to review and select up to six quality measures that meet your needs or specialty. Then download a CSV file of the selected measures for your records.
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2019 Final Rule Removed Quality Measures PDF
View this quick reference document from HealthInsight to see which Quality measures were removed from the 2019 MIPS Quality Performance Category in the 2019 Final Rule.
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2019 QPP Measure Specification and Measure Flow Guides PDF
CMS released two guides to help with guidance on the 2019 MIPS clinical quality measure (CQMs) submissions. The 2019 QPP Measure Specification and Measure Flow Guide for MIPS Clinical Quality Measures gives detailed descriptions of the quality measures, intended to be utilized by individual MIPS eligible clinicians submitting CQMs via Quality Clinical Data Registry (QCDR) or Qualified Registries and by groups submitting via Qualified Registry for the 2019 QPP.
The 2019 QPP Measure Specification and Measure Flow Guide for Medicare Part B Claims Measures gives detailed descriptions of the quality measures, intended to be utilized by individual MIPS eligible clinicians submitting individual measures via Medicare Part B claims for the 2019 QPP.
2019 Claims Data Submission Fact Sheet PDF
This CMS factsheet details how to submit quality data through claims in 2019.
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2019 MIPS Cost User Guide PDF
Download this comprehensive guide from CMS for details on how to participate in the Cost performance category of MIPS in 2019.
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Cost Category Information for Providers PDF
View this informational one-page flyer from HealthInsight for a high-level overview of the Cost Category, how the score is calculated and review helpful hints.
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Cost Fact Sheet PDF
View this CMS fact sheet for a comrehensive overview of what the MIPS Cost Performance Category is and how CMS scores for cost, as well as other valuable links.
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CMS Quality Payment Program – Cost Requirements Page Link
Cost is an important part of MIPS because it measures resources that clinicians use to care for patients and the Medicare payments for care (items and services) given to a beneficiary during an episode of care. Use this interactive CMS website to review and select cost measures.
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MIPS: Summary of 2019 Cost Measures PDF
This document from CMS provides a comprehensive overview of cost measures in relation to the MIPS in the 2019 performance year.
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Cost Performance Category: Episode Measures PDF
Beginning with the 2019 MIPS performance period, eight episode-based measures are also being used to evaluate cost. Episode-based measures differ from the TPCC and MSPB measures because episode-based measure specifications only include items and services that are related to the episode of care for a clinical condition or procedure as opposed to including all services that are provided to a patient over a given time. Below are the links to the Measure Information Forms for each measure, provided by CMS. Use these overviews to find out more about the measures:
- Elective Outpatient Percutaneous Coronary Intervention (PCI)
- Knee Arthroplasty
- Revascularization for Lower Extremity Chronic Critical Limb Ischemia
- Routine Cataract Removal with Intraocular Lens (IOL) Implantation
- Screening/Surveillance Colonoscopy
- Intracranial Hemorrhage or Cerebral Infarction
- Simple Pneumonia with Hospitalization
- ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI)
Total Per Capita Cost (TPCC) PDF
The Total Per Capita Costs for All Attributed Beneficiaries (TPCC) measure is a payment-standardized, annualized, risk-adjusted, and specialty-adjusted measure that evaluates the overall cost of care provided to beneficiaries attributed to clinicians, as identified by a unique Taxpayer Identification Number/National Provider Identifier (TIN-NPI). The Total Per Capita Costs for All Attributed Beneficiaries measure can be reported at the TIN or the TIN-NPI level. See this document from CMS to learn more.
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Medicare Spend Per Beneficiary (MSPB)
The Medicare Spending Per Beneficiary (MSPB) clinician measure assesses the cost to Medicare of services performed by an individual clinician during an MSPB episode, which comprises the period immediately prior to, during, and following a patient’s hospital stay. See this document from CMS to learn more.
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2019 Promoting Interoperability Quick Start Guide PDF
A CMS guide to help clinicians get started participating in the Promoting Interoperability performance category of the Merit-based Incentive Payment System (MIPS) during the 2019 performance year.
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2019 Promoting Interoperability Exceptions FAQs PDF
This document from CMS lists questions and answers on topics related to the 2019 Promoting Interoperability (PI) hardship exception and extreme and uncontrollable circumstances exceptions.
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2019 MIPS Promoting Interoperability Fact Sheet PDF
This comprehensive CMS fact sheet provides an overview of the MIPS Promoting Interoperability performance category, which promotes patient engagement and the electronic exchange of health information using certified electronic health record technology (CEHRT). Updated 8/14/2019.
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2019 Promoting Interoperability Information Blocking Fact Sheet PDF
This CMS fact sheet describes the requirements for MIPS eligible clinicians to prevent actions that block the exchange of health information.
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CMS Quality Payment Program – Promoting Interoperability (formerly Advancing Care Information) Requirements Page Link
This performance category promotes patient engagement and electronic exchange of information using certified electronic health record technology (CEHRT). CMS re-named the advancing care information (ACI) performance category to promoting interoperability (PI) to focus on interoperability, improving flexibility, relieving burden. This interactive webpage from CMS provides an overview about PI objectives and measures and how to report them. You can also use the online interactive tool to select your measures.
2019 Promoting Interoperability Measure Specifications Link
This Zip file contains a detailed overview of the requirements for the 2019 Promoting Interoperability performance category objectives and measures straight from CMS.
Patient Engagement Playbook Link
Patient engagement can have big benefits for your practice and your patients: better communication, better care, and better outcomes. Health information technology (health IT) is a powerful tool to help you get there — so learn how to make it work for you, using the Patient Engagement Playbook as your guide. The Playbook is an evolving resource from the Office of the National Coordinator for Health Information Technology for clinicians, practice staff, hospital staff, and other innovators: a compilation of tips and best practices.
EHR Adoption Link
View this page of resources specifically for those providers needing help with EHR adoption from HealthInsight and others.
Access HealthInsight’s EHR database
2019 Improvement Activities Quick Start Guide PDF
A CMS guide to help clinicians get started participating in the MIPS Improvement Activities performance category during the 2019 performance year.
2019 Improvement Activities Guide PDF
CMS guide detailing how to participate in the Improvement Activities performance category of MIPS in 2019.
Integrating with the Quality Payment Program: Making Current improvement Activities Work for You PDF
Get a brief overview about MACRA and the Quality Payment Program in this flyer from HealthInsight, and then learn about the Improvement Activities category under MIPS and what might apply to your practice.
Improvement Activities Fact Sheet PDF
View this comprehensive CMS fact sheet to see what the MIPS Improvement Activities Performance Category is and how to choose and submit Improvement Activities that apply to your practice, as well as other valuable links.
2019 Improvement Activities Inventory Link
Use this link to download a Zip file with the full list of CMS 2019 Improvement Activities in both PDF and Excel format.
2019 Improvement Activities Data Validation Criteria PDF
Use this CMS resource to see what documentation is recommended to attest to the different activities listed in the 2019 Improvement Activities performance category.
2019 MIPS Improvement Activities Performance Category Data Validation Changes PDF
This document from CMS outlines the changes in the 2019 MIPS Improvement Activities Performance Category data validation criteria document from 2018.
CMS Quality Payment Program – Improvement Activities Requirements Page Link
This performance category gauges participation in activities that improve clinical practice. This interactive webpage from CMS provides an overview about the Improvement Activities category under MIPS, allows you to review and select activities that best fit your practice, and download a CSV file of the selected activities for your records.
Wyoming – Prescription Drug Monitoring Program Videos
The CMS Quality Improvement Organization (QIO) Program has made an effort to record and post information about individual state Prescription Drug Monitoring Programs (PDMPs). The purpose of these short recordings is to promote use and increase understanding of the similarities and differences between state PDMPs. See the videos and slides for Wyoming below:
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2018 MIPS Performance Feedback Beneficiary-Level Data Reports Supplement PDF
CMS is providing beneficiary-level cost data reports to clinicians and groups who were scored on the MIPS Total Per Capita Costs for All Attributed Beneficiaries (TPCC) measure and the MIPS Medicare Spending per Beneficiary (MSPB) cost measure in 2018.
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2020 MIPS Payment Adjustment Fact Sheet PDF
This CMS fact sheet provides a general overview of the 2020 payment adjustments based on MIPS final scores for the 2018 performance year.
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2017 & 2018 MIPS Data Validation and Audit Fact Sheet PDF
This CMS fact sheet provides an overview of the Merit-based Incentive Payment System (MIPS) data validation and audit process that will be conducted in 2019 for the 2017 and 2018 performance years.
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2018 Targeted Review User Guide PDF
This CMS user guide will help those requesting a targeted review. It outlines the vital steps of requesting a targeted review. Review your 2018 MIPS performance feedback and 2020 MIPS payment adjustment factor(s) as soon as they’re available. If you believe there is an error with your 2018 MIPS performance feedback, submit your targeted review request immediately. Targeted reviews can be requested until September 30, 2019.
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2019 CMS Web Interface Fact Sheet PDF
This CMS document provides an overview of the CMS Web Interface in 2019.
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2019 MIPS Scoring Guide PDF
View this CMS guide that provides details about how scores are calculated for MIPS in the 2019 performance year.
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2019 Quality Payment Program Audit Documentation PDF
This guide will assist clinicians and practices in collecting and saving Medicare Quality Payment Program (QPP) documentation, so it is readily available if selected for an audit. All materials should be kept for 10 years.
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2019 MIPS Payment Adjustment FAQs and Resources PDF
This CMS information sheet is a shorter version of the CMS 2019 Payment Adjustment Fact Sheet that outlines some of the most frequently asked questions and points users to resources that may be helpful in understanding more about the application of payment adjustments based on 2017 MIPS final scores.
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HARP Account Setup Checklist PDF
Use this informative and simple one-page flyer from HealthInsight to understand the steps needed to complete your HARP Account Setup.
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MIPS 2020 Virtual Groups Toolkit
CMS has released this toolkit to help you understand and complete the election process to participate in MIPS as a virtual group in 2020. This includes the 2020 virtual groups overview fact sheet and the election , an overview of the election process guide. The link provides access to a downloadable zip file with all the materials.
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HARP Frequently Asked Questions Link
The HCQIS Access Roles and Profile (HARP) is a secure identity management portal provided by CMS. View this webpage to get answers to frequently asked questions and other help for the new HARP system.
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HARP User Guides Link
Creating a HARP account provides users with a user ID and password that can be used to sign into many CMS applications, as well as providing a single location for users to modify their user profile, change their password, update their challenge question, and add and remove two-factor authentication devices. Use this link to download a Zip file that contains the four new user guides. These guides will help you know how to get started, how to register for a HARP account, how to connect to an organization, and how to manage access for security officials.
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HARP Videos Link
CMS released short videos to help guide you through the HARP Account system and how to set up your account. View these here:
Create a QPP Account
Reviews how to register for create a new HARP account.
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Connect to an Organization: Practice
Reviews how to request access (“connect”) to a practice so you can view, submit and manage data on behalf of the practice.
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Connect to an Organization: APM Entity
Reviews how to request access (“connect”) to an Alternative Payment Model (APM) Entity so you can view, submit and manage data on behalf of the APM.
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Connect to an Organization: Registry
Reviews how to request access (“connect”) to a Registry or QCDR so you can submit data on behalf of your customers.
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Connect to an Organization: Virtual Group
Reviews how to request access (“connect”) to a virtual group so you can view, submit and manage data on behalf of the virtual group.
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Security Officials: Approving Role Requests
Shows how a security official can approve and deny requests from staff users.
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2019 MIPS Data Validation Fact Sheet PDF
Data validation is the process of ensuring that a program operates with accurate and useful data. MIPS requires all-payer data for all collection types except for the Medicare Part B claims and the CMS Web Interface collection types. Use this comprehensive CMS fact sheet for an overview of the data validation criteria for each MIPS performance category.
2019 Payment Adjustment Infographic Link
Data validation is the process of ensuring that a program operates with accurate and useful data. MIPS requires all-payer data for all collection types except for the Medicare Part B claims and the CMS Web Interface collection types. Use this comprehensive CMS fact sheet for an overview of the data validation criteria for each MIPS performance category.
2019 MIPS Payment Adjustment Fact Sheet Link
This comprehensive fact sheet from CMS reviews important program definitions and 2017 MIPS eligibility & exclusion criteria, discusses how CMS assigns scores to MIPS eligibleclinicians, explains how payment adjustment factors are applied, resulting in actual adjustments to payments for covered professional services furnished by MIPS eligible clinicians in CY 2019, and much more.
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2019 MIPS Payment Adjustment Remittance Advice FAQs Link
In July 2018, each MIPS eligible clinician received a 2017 MIPS final score and associated payment adjustment factor(s) as part of their 2017 MIPS performance feedback, available on the QPP website. This FAQ from CMS addresses frequently asked questions about the application of payment adjustments, which began January 1, 2019.
How to Add a New Clinician Role for the QPP (5 min) Video
This video from CMS provides step-by-step instructions on how to add the new clinician role for the QPP. The new role allows clinicians to view their MIPS eligibility details, performance feedback and payments adjustment without having to request access.
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2019 Cost Performance Category Overview (60 min) Video
This CMS webinar recording provides an overview of the Cost performance category of MIPS in the 2019 performance year of the Quality Payment Program. View the slide deck here.
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2019 Promoting Interoperability Performance Category Overview (60 min) Video
This CMS webinar recording provides an overview of the Promoting Interoperability performance category of MIPS in 2019. View the slide deck here.
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101 Webinar on APMs in 2019 (60 min) Video
Provides a basic overview of Alternative Payment Models (APMs) for the 2019 Performance Year of the Quality Payment Program. View the slide deck here.
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2019 Merit-based Incentive Payment System (MIPS) Overview (11 min) Video
Overview of the Quality Payment Program Merit-based Incentive Payment System (MIPS) for the 2019 performance period.
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2019 MIPS Quality Performance Category Overview (63 min) Video
Provides an overview of the Quality performance category of the Merit-based Incentive Payment System (MIPS) in the 2019 performance year of the Quality Payment Program.
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How to Access Performance Feedback for Groups (13 min) Video
This CMS video will provide an overview of how to access 2017 MIPS performance feedback for clinicians who participated as a group.
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How to Request a Targeted Review (7 min) Video
Demonstrates how MIPS eligible clinicians or groups can request a targeted review of their 2019 MIPS payment adjustment.
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How to Access Performance Feedback for Voluntary Submitters (4 min) Video
Provides an overview of how to access 2017 performance feedback data for a clinician who voluntarily submitted data for 2017.
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How to Access Performance Feedback for Individuals (9 min) Video
Demonstrates how to access 2017 MIPS performance feedback for a clinician whose performance was scored separately from his or her group.
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How to Access Performance Feedback for APM Entities (7 min) Video
Provides an overview of how to access 2017 MIPS performance feedback for Alternative Payment Model (APM) Entities.
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Identify and Compare APMs (including ACOs) in a Region or Area PDF
Often system(s) clinics, or providers are not aware of what APMs they are involved with. Learn how to identify and compare APMs in your specific region/area by looking this information up with this helpful walkthrough from Comagine Health.
ACO Lookup Tool Version 1 PDF
Explore what Medicare ACOs are in your state and what their performance is on key measures. This data is from Medicare Public Use Files and is updated annually. For more information on ACO options, see our other resources, the QPP Advanced Alternative Payment Models overview and the Identify and Compare APMs (Advanced Payment Models – including ACOs) in a Region or Area walkthrough below. Version one is broader and looks at multiple ACOs.
ACO Lookup Tool Version 2 PDF
Explore what Medicare ACOs are in your state and what their performance is on key measures. This data is from Medicare Public Use Files and is updated annually. For more information on ACO options, see our other resources, the QPP Advanced Alternative Payment Models overview and the Identify and Compare APMs (Advanced Payment Models – including ACOs) in a Region or Area walkthrough below. Version two is more focused and looks closer at one ACO. Data is the same.
2019 Scores for Improvement Activities in MIPS APMs PDF
This guide from CMS provides an overview of scoring of IA in MIPS APMs in Year 3 (2019) of QPP.
Advanced Payment Models Toolkit PDF
Are you confused about Alternative Payment Models (APMs), Advanced APMs, MIPS APMs and Accountable Organizations (AOs) such as Accountable Care Organizations (ACOs), Convener Participants (CPs) and Direct Contracting Entities (DCEs)? This toolkit from Comagine Health combines definitions and checklists to help you determine your compatability with eligible AOs in your region. There are also readiness checklists for Primary Care and Specialists, along with other important resources to consider. Each page can be printed separately so that you can decide what tools you need.
Are you considering joining an accountable care organization (ACO)? PDF
Understanding the pros, cons, aspects to consider and questions to ask.
2019 List of Alternative Payment Models PDF
This CMS fact sheet displays the comprehensive list of Alternative Payment Models.
2019 APM Incentive Payment Fact Sheet PDF
This CMS fact sheet provides an overview of information on 5 percent APM Incentive Payment for 2017 Performance.
2019 Scores for Improvement Activities in MIPS APMs PDF
This guide from CMS provides an overview of scoring of IA in MIPS APMs in Year 3 (2019) of QPP.
QPP Advanced Alternative Payment Models PDF
Curious about Alternative Payment Models (APMs), Advanced APMs, Accountable Care Organizations (ACOs) and MIPS APMs? This overview from HealthInsight gives a brief outline of each, guidance for enrollment and evaluation, and other resources.
Identify and Compare APMs (Advanced Payment Models – including ACOs) in a Region or Area PDF
Often system(s) clinics, or providers are not aware of what APMs they are involved with. Learn how to identify and compare APMs in your specific region/area by looking this information up with this helpful walkthrough from HealthInsight.
2019 List of Medicare Health Plan Other Payer APMs PDF
This document from CMS specifically outlines payment arrangements by Medicare Health Plans that qualify as “other-payer” Advanced Alternative Payment Models (APMs) for 2019.
2019 Medicare Shared Savings Program and QPP Interactions Overview PDF
This CMS resource provides an overview of the interactions between the Medicare Shared Savings Program (SSP) and the Quality Payment Program (QPP) during the 2019 performance period.
A Guide to Physician-Focused Alternative Payment Models Link
View this informative guide on APMs from the American Medical Association and the Center for Healthcare Quality and Payment Reform.
2019 QPP Multi-Payer Other Payer Advanced APMs PDF
A list from CMS of payment arrangements with CMS Multi-Payer APMs that CMS has determined to be Other Payer Advanced APMs for Qualifying Participants (QPs) during the 2019 performance period (applicable for Hawaii).
eCQI Toolkit Link
Mountain-Pacific Quality Health’s electronic Clinical Quality Improvement (eCQI) toolkit utilizes aspects of an agile delivery cycle, which focuses on achieving value added changes quickly and efficiently, one change at a time. These systematic improvement cycles are called “sprints”. The goal of each sprint is to provide value added results for your organization approximately every 2-6 weeks and is based on the PDSA iterative quality improvement cycle.
eCQI Resource Center Tool Library Link
The electronic Clinical Quality Improvement (eCQI) page on the eCQI Resource Center offers tools and resources that provide a foundation for the development, testing, certification, publication, implementation, reporting, and continuous evaluation of quality measures and their improvement. You can refine the tool list by selecting a category of interest and/or a role that best describes your needs, or you can also click a specific tool from the list below to view additional details.
The Payment Reform Glossary PDF
Learn more about payment reform with this comprehensive guide from the Center for Healthcare Quality and Payment Reform.
Click here to see our upcoming webinars and events.
6/20/2019, MIPS Tips – Strengthening Primary Care – Webinar
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5/17/2019, MIPS Tips – Interoperability and the Exchange of Data – Webinar
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4/18/2019, MIPS Tips – QPP for New Clinicians or Practice Managers – Webinar
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3/14/2019, MIPS Tips – Facility-based Scoring – Webinar
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2/14/2019, MIPS Tips – Open Office: Lessons Learned from 2017 & 2018 – Webinar
This session focuses on MIPS reporting by sharing information from the 2017 feedback reports.
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1/17/2019, MIPS Tips – 2018 Data Submission Office Hours – Webinar
This webinar focuses on the security risk assessment (SRA), which is a common audit failure in the promoting interoperability performance category. Presenters will help you learn how to ensure your clinic has completed it accurately.
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12/13/2018, MIPS Tips – 2019 QPP Final Rule
CMS publishes an updated set of administrative rules regarding QPP each year. This session provides a review of the most recent set of rules affecting the 2019 Performance Year.
10/25/2018, MIPS Tips – What is Hierarchical Condition Category (HCC) and How Does It Impact the MIPS Cost Category?
This session will review the measures of the cost category with an emphasis on how HCC coding is used for risk scoring. Risk scoring affects the expected cost and can have a significant impact on the ratios used for scoring.
9/18/2018, MIPS Tips – Quality Improvement and MIPS
This session focuses on using QPP and feedback reports for improvement and innovations in your clinic/organization.
8/16/2018, MIPS Tips – Feedback Reports
7/17/2018, Understanding MIPS for Specialties: Advice for Solo and Small Group Practices
6/14/18, MIPS Epic EHR Workflows
6/13/18, CPC+ Epic workflows LAN
6/12/2018, Using Data and Strategy to Succeed in MIPS Year Two: Advice for Solo and Small Group Practices
6/7/2018, MIPS Tips – Advanced Alternative Payment Models (Advanced APMs)
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5/15/2018, Succeeding in MIPS: Advice from Peers in Solo & Small Group Practices
5/10/2018, MIPS Tips – Year 2 Deep Dive and Aligned MIPS Strategy
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4/17/2018, Using Improvement Activities to Enhance Performance Scores for Solo Practitioners and Small Group Practices
4/12/2018, MIPS Tips – MIPS & Cybersecurity
Our new MIPS Tips events will include: a brief overview of the steps you need to take to report to the Merit-based Incentive Payment System (MIPS) in 2017; what you need to do to be successful in 2018; a question-and-answer session with Medicare Quality Payment Program experts from HealthInsight and Mountain-Pacific Quality Health.
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3/28/2018, MIPS Tips
Our new MIPS Tips events will include: a brief overview of the steps you need to take to report to the Merit-based Incentive Payment System (MIPS) in 2017; what you need to do to be successful in 2018; a question-and-answer session with Medicare Quality Payment Program experts from HealthInsight and Mountain-Pacific Quality Health.
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3/20/2018, How to Prepare for MIPS Cost Scoring: Practical Advice for Solo Practitioners and Small Group Practices
3/8/2018, MIPS Tips
Our new MIPS Tips events will include: a brief overview of the steps you need to take to report to the Merit-based Incentive Payment System (MIPS) in 2017; what you need to do to be successful in 2018; a question-and-answer session with Medicare Quality Payment Program experts from HealthInsight and Mountain-Pacific Quality Health.
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2/28/2018, MIPS Tips
Our new MIPS Tips events will include: a brief overview of the steps you need to take to report to the Merit-based Incentive Payment System (MIPS) in 2017; what you need to do to be successful in 2018; a question-and-answer session with Medicare Quality Payment Program experts from HealthInsight and Mountain-Pacific Quality Health.
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2/20/2018, MIPS Data Submission: Practical Advice for Small Group Practices and Solo Practitioners
2/8/2018, MIPS Tips
Our new MIPS Tips events will include: a brief overview of the steps you need to take to report to the Merit-based Incentive Payment System (MIPS) in 2017; what you need to do to be successful in 2018; a question-and-answer session with Medicare Quality Payment Program experts from HealthInsight and Mountain-Pacific Quality Health.
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1/24/2018, MIPS Tips
Our new MIPS Tips events will include: a brief overview of the steps you need to take to report to the Merit-based Incentive Payment System (MIPS) in 2017; what you need to do to be successful in 2018; a question-and-answer session with Medicare Quality Payment Program experts from HealthInsight and Mountain-Pacific Quality Health.
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1/25/2018, MIPS Data Submission: Practical Advice for Small Group Practices and Solo Practitioners
1/11/2018, MIPS Tips
Our new MIPS Tips events will include: a brief overview of the steps you need to take to report to the Merit-based Incentive Payment System (MIPS) in 2017; what you need to do to be successful in 2018; a question-and-answer session with Medicare Quality Payment Program experts from HealthInsight and Mountain-Pacific Quality Health.
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12/14/2017, Overcoming Challenges to MIPS for Solo Practitioners and Small Group Practices
11/16/2017, MIPS Question and Answer Town Hall Event for Small Practices and Solo Practitioners
9/19/2017, QPP Webinar Series – 2 minute Warning
Join this information session to understand what it means to participate in MIPS with a test, partial and full reporting submission, and the benefits to participating to the greatest extent possible this year. Leave the session with a clear plan for gathering and reporting your performance data in each MIPS category. The first part of this session will include a review of all the steps you need to take to report for 2017. The second half will be an open question and answer session with MIPS experts.
9/12/2017, Picking Quality Measures and Improvement Activities for MIPS Reporting
8/1/2017, The Mechanics Of MIPS Data Submission
7/11/2017, QPP Webinar Series – Improving Your Score with eCQI
This learning session includes information about using the electronically enabled clinical quality improvement (eCQI) process to select areas for improvement and how to use a methodology to guide the improvement process.
6/27/2017, QPP Webinar Series – Submission and Scoring Methods
This webinar offers an in-depth look at how to score the different MIPS categories (Improvement Activities, Advancing Care Information, Quality and Costs) and their submission methods.
6/20/2017, QPP Webinar Series – Nine Steps to Reporting MIPS
Get a quick summary of MACRA and the Merit-based Incentive Payment System (MIPS) and learn the nine essential steps for ensuring readiness for MIPS requirements.
6/8/2017, Preparing For MIPS In The Small Group Practice
5/23/2017, QPP Webinar Series – MIPS Deep Dive: Advancing Care Information and Costs
This session includes a deeper dive into two components of the MIPS portion of the Quality Payment Program: Advancing Care Information and Costs. Also, get information about tools you can immediately use to assess your costs and how to improve interoperability.
5/16/2017, QPP Webinar Series – MIPS Deep Dive
Dive into the MIPS portion of the Quality Payment Program and get information about how you can be successful in MIPS, how to choose quality measures, how to improve quality measures, documentation and reporting and how to complete an improvement activity.
5/9/2017, QPP Webinar Series – QPP Overview
This learning session offers a broad overview of the Quality Payment Program, including who it impacts, what it is, when it starts, how it fits into the big health care picture and how to be successful in it.
Influenza Prevention Strategies for Adults 65 and Older
The National Foundation for Infectious Diseases (NFID) has partnered with mdBriefCase Group Inc. to offer a complimentary online Continuing Medical Education (CME) activity offering strategies to help prevent influenza in patients age 65 years and older. This on-demand program provides a framework for counseling adults age 65 years and older on the importance of annual influenza vaccination through case-based scenarios and can benefit all providers in all Task areas.
Upon completion of this activity, participants will be able to:
- Describe the benefit of influenza vaccination in adults age 65 years and older
- List the vaccine options available for seasonal influenza vaccination of adults age 65 years and older
- Differentiate vaccine products approved for seasonal influenza in adults age 65 years and older
- Effectively counsel older adult patients about the importance of seasonal influenza vaccination
Please note that participants will be required to create an mdBriefCase account to access the online program, but there is no fee to participate in this activity. If interested, the program can be accessed at Influenza Prevention Strategies.
The Medicare Learning Network® (MLN)
Learning Management System (LMS)
See this tool to learn how to access the LMS.
Quality Payment Program (QPP) in 2017: Pick Your Pace – A CMS Module
How do you know if your medical practice needs to participate in the Quality Payment Program in 2017? The Medicare Learning Network Management Systems offers a simple, online and self-paced course on participating in the Quality Payment Program and picking a pace that works for your practice. The course provides information on:
- The basics of the Quality Payment Program;
- Steps to take to actively participate in the Quality Payment Program to avoid a payment penalty and possibly earn a positive payment adjustment;
- Factors to consider in choosing how to participate in the program through either the Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (APM).
Users will be required to create an account in the Medicare Learning Network Management System to view the course.
Accreditation Council for Continuing Medical Education (ACCME) Designation Statement: The Centers for Medicare & Medicaid Services designates this enduring material for a maximum of 0.5 American Medical Association (AMA) Physician’s recognition Award (PRA) Category 1 Credit TM
Quality Payment Program Overview (May 2017) (Contact hours: 37 minutes)
Learn about the origin and goals of Medicare’s Quality Payment Program (QPP); recognize the four performance categories within the Merit-based Incentive Payment System (MIPS); identify the three criteria to be considered an Advanced Alternative Payment Model (Advanced APM); and use resources available for QPP. Users will be required to create an account in the Medicare Learning Network Management System to view the course. The Centers for Medicare & Medicaid Services designates this enduring material for a maximum of 0.5 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit for this course expires June 1, 2020. AMA PRA Category 1 Credit™ is a trademark of the American Medical Association.
Quality Payment Program 2017 Merit-based Incentive Payment System: Improvement Activities Performance Category (July 2017) (Contact hours: 24 minutes)
Learn about the Improvement Activities performance category requirements, and how this category fits into the larger Quality Payment Program; the steps you need to take to report Improvement Activities data to CMS; and the basics about scoring. Users will be required to create an account in the Medicare Learning Network Management System to view the course. The Centers for Medicare & Medicaid Services designates this enduring material for a maximum of 0.5 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit for this course expires July 14, 2020. AMA PRA Category 1 Credit™ is a trademark of the American Medical Association.
Quality Payment Program 2017: Merit-based Incentive Payment System (MIPS) Quality Performance Category (August 2017) (Contact hours: 25 minutes)
Learn about the Quality performance category requirements, and how this category fits into the larger Quality Payment Program. Users will be required to create an account in the Medicare Learning Network Management System to view the course. The Centers for Medicare & Medicaid Services designates this enduring material for a maximum of 0.5 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit for this course expires August 3, 2020. AMA PRA Category 1 Credit™ is a trademark of the American Medical Association.
Quality Payment Program in 2017: Advanced Alternative Payment Models (October 2017) (Contact hours: 28 minutes)
Learn about Advanced Alternative Payment Models (APMs), including identifying Advanced APMs and CMS Advanced APMs and how to participate in the Quality Payment Program via an Advanced APM. Users will be required to create an account in the Medicare Learning Network Management System to view the course. The Centers for Medicare & Medicaid Services designates this enduring material for a maximum of 0.5 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit for this course expires October 30, 2020. AMA PRA Category 1 Credit™ is a trademark of the American Medical Association.
2019 Facility-based Measurement Fact Sheet PDF
This comprehensive CMS fact sheet describes the process used to assess performance at the facility level for select Merit-based Incentive Payment System (MIPS) eligible clinicians, groups, and virtual groups whose primary health care responsibilities take place in hospital settings.
Hospital Value-Based Purchasing Program Link
CMS’ Hospital Value-Based Purchasing (VBP) Program rewards acute care hospitals with incentive payments for the quality of care they give to people with Medicare. Visit this CMS webpage to find out more about this program and view helpful resources and links.
2019 Facility-based Preview FAQs PDF
This CMS resource answers frequently asked questions about the 2019 Facility-based Preview for select MIPS eligible clinicians, groups, and virtual groups whose primary health care responsibilities take place in hospital settings.
QPP Newsletters
Jun-2018 PDF
May-2018 PDF
Apr-2018 PDF
Mar-2018 PDF
Feb-2018 PDF
Jan-2018 PDF
Dec-2017 PDF
Nov-2017 PDF
Oct-2017 PDF
Sep-2017 PDF
Aug-2017 PDF
Jun-2017 PDF
Apr-2017 PDF
Specialty Packets
These specialty packets from Mountain-Pacific Quality Health contain applicable measures for the Quality, Promoting Interoperability and Improvement Activities categories along with helpful scoring information. Use these as a starting point for your 2019 MIPS action plan or to review your current plan to confirm you are on the right track.
2019 Anesthesiology and CRNA Measures PDF
2019 Cardiology Measures PDF
2019 Dermatology Measures PDF
2019 Emergency Medicine Clinicians Measures PDF
2019 Gastroenterology Measures PDF
2019 General Surgeons Measures PDF
2019 Hospitalists Measures PDF
2019 Pathology Measures PDF
2019 Physical and Occupational Therapists Measures PDF
2019 Podiatry Measures PDF
2019 Primary Care Measures PDF
2019 Ophthalmology Measures PDF
2019 Optometry Measures PDF
2019 Oncologist Measures PDF
2019 Orthopedic Measures PDF
2019 Radiology Measures PDF
2019 Urologist Measures PDF
CMS Specialty Packets
These specialty packets from CMS highlight measures and activities for MIPS performance categories that apply to MIPS eligible clinicians in 2019.
2019 Measures and Activities for Cardiologists PDF
2019 Measures and Activities for Chiropractors PDF
2019 Measures and Activities for Dentists PDF
2019 Measures and Activities for Emergency Medicine Clinicianss PDF
2019 Measures and Activities for Nurse Practitioners PDF
2019 Measures and Activities for Ophthalmologists PDF
2019 Measures and Activities for Optometrists PDF
2019 Measures and Activities for Orthopedists PDF
2019 Measures and Activities for Pathologists PDF
2019 Measures and Activities for Physician Assistants PDF
2019 Measures and Activities for Podiatrists PDF
2019 Measures and Activities for Radiologists PDF
2019 Measures and Activities for Anesthesiologists and Certified Nurse Anesthetists PDF
2019 Measures and Activities for Clinical Psychologists PDF
2019 Measures and Activities for Dietitians and Nutrition Professionals PDF
2019 Measures and Activities for Occupational and Physical Therapists PDF
2019 Measures and Activities for Primary Care Clinicians PDF
2019 Measures and Activities for Speech Language Pathologists PDF
Disease Topic Packets
The Quality Payment Program (QPP) and Mountain-Pacific’s Diabetes Program
Mountain-Pacific Quality Health sponsors Diabetes Empowerment Education Program (DEEP)TM classes across the state. We can help you meet QPP requirements under the Merit-based Incentive Payment
System (MIPS) by highlighting two Performance Categories: Improvement Activities and Quality Measures. See this tool to learn more.
QPP ABS Crosswalk Checklist
Checklist for Core Elements of Outpatient Antibiotic Stewardship with Quality Payment Program Crosswalk.
Cardiac Reporting Toolkit
A Guide to Cardiac Quality and Alignment with the CMS Quality Payment Program