What Are The New Quality Payment Program Rules?

June 28th, 2017 - By Matt Garnese

The Centers for Medicare and Medicaid Services (CMS) published its proposed year 2 rules for the Quality Payment Program (QPP) with feedback from physician stakeholders in order to improve the policies that were laid out in 2017.

Check Requirements for MIPS or APM Reporting

If you receive Medicare payments, either through Merit-based Incentive Payment System (MIPS) or an Alternative Payment Model (APM), you are expected to participate. In order to receive positive payment adjustments, submit your quality measures as outlined by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

You have a few different options to submit your 2017 quality data. If you submit the minimum amount of data for 2017 (at least one quality metric) you will avoid negative payment adjustment. You may also submit quality data for part of the year (one fiscal quarter, 90 days) and receive a neutral or positive payment adjustment, or, if you submit data for the entire year, you will receive a positive payment adjustment. Doctors who receive Medicare payments and do not submit quality measures will receive a negative adjustment of 4%.

To check if your practice receives participates in MIPS, visit the MIPS participation lookup web page and enter your National Provider Identifier (NPI).

Proposed Rules for the Quality Payment Program in 2018

Here are a few significant changes to the QPP:

  • The threshold to exclude individual MIPS eligible clinicians or groups has been raised from ≤$30,000 those with with ≤$90,000 in charges.
  • Quality data can now be submitted through more than one submission mechanism within a performance category.
  • The data completeness threshold has been raised from %50 to %60 for the 2019 MIPS submission period; measures that do not meet the completeness criteria will receive only one point (In 2017 the rule was three points); small practices will still receive three points.
  • Small practices (those with 15 or fewer clinicians) will be automatically awarded five points to the final score if the eligible clinician/group submits data for at least one performance category during the applicable performance period.
  • The performance threshold has been set at 15 points. CMS has requested further stakeholder feedback about whether this score should be higher or lower.

If you want to read the full text regarding these changes, read the CMS Proposed Rule Fact Sheet.

MACRA Reporting and Your EHR Software

For eligible clinicians using PrognoCIS EHR, we will complete certification testing for MACRA, with time for providers to enter and report data that may earn a neutral or positive payment adjustment and may even earn the maximum QPP adjustment. Practitioners who already enjoy using PrognoCIS will have all the tools and reporting capabilities of a MACRA-certified application, which gracefully dovetails into the application, similar to our previous implementation of Meaningful Use reporting criteria. PrognoCIS EHR is customizable to any specialty–ambulatory practices, family medicine, pain management, podiatry, occupational medicine, and more.

In conjunction with certification, we will host a series of webinars delivering to you all relevant updates when certification has been completed.

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