PFS/MACRA/QPP

Jan 3, 2018
Individual clinicians and group practices participating in the Quality Payment Program can submit their 2017 performance data through March 31 at https://qpp.cms.gov/login, eliminating the need to submit the data on multiple websites, the Centers for Medicare & Medicaid Services announced…
Jan 18, 2018
More than 20,000 clinicians will receive between 6.6% and 19.9% more on their Medicare physician fee schedule payments in 2018 due to high performance on quality and cost measures in 2016 under the final value modifier adjustment, the Centers for Medicare & Medicaid Services announced …
Jan 12, 2018
The Medicare Payment Advisory Commission yesterday recommended that Congress increase Medicare base payment rates for hospital inpatient and outpatient services by 1.25% in 2019, as provided under current law. In other voting, the commission recommended that the Health and Human Services Secretary…
Jan 10, 2018
The Centers for Medicare & Medicaid Services will accept applications through March 12 for a new voluntary bundled payment model that will qualify as an advanced alternative payment model under Medicare’s Quality Payment Program for clinicians. Announced yesterday, the Bundled Payments for Care…
Jan 9, 2018
To translate clinicians’ MIPS final performance scores into payment adjustments, CMS will identify several final score thresholds.
A performance threshold. Clinicians who score above the performance threshold will receive positive payment adjustments on a sliding scale, and clinicians who score below the threshold will receive negative payment adjustments on a sliding scale. CMS will publish the performance threshold prior…
Jan 8, 2018
The quality payment program (QPP) creates new quality measurement and reporting requirements for eligible clinicians and the hospitals with whom they partner.
However, the QPP’s payment implications will vary depending on a number of scenarios – such as whether a clinician is attributed to the Merit-Based Incentive Payment System (MIPS)i; to a MIPS alternative payment model (APM); or to an advanced APM. See Figure 1. While MIPS-eligible clinicians have a…
Jan 8, 2018
Some clinicians who participate in APMs will not qualify for exemption from the Merit-based Incentive Payment System (MIPS), nor the advanced APM payment incentives, either because the APM does not qualify as an advanced APM (such as Track 1 of the Medicare Shared Savings Program (MSSP)), or because the clinician did not meet the participation thresholds to qualify for MIPS exemption. However, some advantages still exist for clinicians subject to MIPS who also participate in certain Medicare APMs.
Specifically, CMS has designated certain Medicare APMs as “MIPS APMs.” In 2017, these include Tracks 1, 2 and 3 of the MSSP and the Next Generation Accountable Care Organization (ACO) program. A full list of APMs that qualify as MIPS APMs is available on CMS’s website. Clinicians who participate in…
Jan 8, 2018
Clinicians who do not meet the threshold to become a QP but meet a slightly lower threshold of advanced alternative payment model (APM) participation are deemed partial QPs. Partial QPs do not receive the APM incentives but are exempt from the Merit-based Incentive Payment System (MIPS), though they may choose to report and receive MIPS payment adjustments voluntarily. In 2017, clinicians in an advanced APM must meet or exceed either 20 percent of Medicare payments or 10 percent of Medicare patients to be exempt from 2017 MIPS reporting and potential payment adjustments in 2019.
APM entities and clinicians will know their QP or partial QP status before the MIPS election period; CMS anticipates announcing 2017 determinations before Dec. 31, 2017. APM entities or clinicians that are determined to have partial QP status may elect to participate in MIPS. As a default, CMS will…
Jan 8, 2018
Rural providers are not explicitly excluded from the reporting requirements and potential payment adjustments under the new Merit-based Incentive Payment System (MIPS). How rural facilities and clinicians are treated under the MIPS depends on the type of facility and how Medicare is billed for professional services. In addition, clinicians who provide a low volume of Medicare services may be exempted from MIPS. Learn more here.
Method I Critical Access Hospitals (CAHs) Under Method I, the CAH bills Medicare for facility services and clinicians’ professional services separately under the physician fee schedule (PFS). In this case, The Centers for Medicare & Medicaid Services (CMS) will not make MIPS adjustments to a…
Jan 3, 2018
Individual clinicians and group practices participating in the Quality Payment Program can submit their 2017 performance data through March 31 at https://qpp.cms.gov/login, eliminating the need to submit the data on multiple websites, the Centers for Medicare…