Introducing the New Quality Payment Program from CMS

If your practice bills Medicare more than $30,000 a year and provides care for more than 100 Medicare patients, you will now be in the Quality Payment Program established under MACRA, The Medicare Access and CHIP Reauthorization Act of 2015.

The Quality Payment Program replaces the previous Sustainable Growth Rate formula and is broken down into a two-track framework: Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS). Most providers will participate through the MIPS track which will award an incentive or a payment penalty based upon performance on quality, cost, use of electronic health record technology and improvement activities. Participation in the Advanced APM path will require clinicians to take on more financial and technological risk but will yield a 5% lump-sum incentive payment.

Throughout the performance year, practices will need to record the quality of care they provide and the type of technology used. Medicare will utilize this information to give feedback about performance and determine incentive payments and adjustments.

Practices can pick their pace for the Quality Payment Program starting on January 1, 2017 with first payment reimbursements going into effect on January 1, 2019.

  • If MIPS eligible providers don’t participate at all, they can expect a 4% negative payment adjustment
  • If MIPS eligible providers submit one quality measure or one improvement activity for any point in 2017, there would be no adjustments.
  • If MIPS eligible providers submit for a partial year (a minimum of 90 days of 2017 data) they will receive either a neutral or small positive adjustment
  • If MIPS eligible providers submit for Full Year: Submit all 2017 data to Medicare they will receive a moderate positive payment adjustment

Rural Health Clinics and Federally Qualified Health Centers are exempt from reporting under MACRA. However, we encourage voluntary reporting to help those providers stay current with reporting requirements and to help prepare for advanced payment models.

The Consortium’s Practice Transformation Network prepares providers for participation in MACRA as well as in advanced payment models. This program is funded by the Transforming Clinical Practices Initiative from the Centers of Medicare and Medicaid Services (CMS).

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