QPP stands for Quality Payment Program. The Quality Payment Program was designed to improve Medicare by helping physicians focus on the quality of care over service volume. Prior to 2015, physicians were reimbursed on a fee-for-service model. In 2015, QPP was introduced, bringing a two track value-based reimbursement system to replace the existing system.
The two track value-based reimbursement system includes:
● The Merit-based Incentive Payment System (MIPS): Clinicians that participate in MIPS earn a payment adjustment (positive, up to 4%) to Medicare Part B payments made in 2017 for covered services. These will be applied in 2019.
● Advanced Alternative Payment Models (APMs): Clinicians that receive 25% of Medicare payments or see 20% of Medicare patients through an Advanced APM earn a 5% incentive payment in 2019.
QPP Tools have been updated recently by the Centers for Medicare and Medicaid Services (CMS). These online tools aim to help clinicians answer a variety of questions they may face surrounding QPP, eligibility, and exemptions.
The updated QPP Eligibility and Measure Lookup Tools were recently released. The MIPS eligibility lookup tool is especially useful, as it is a web page that allows physicians (and other eligible clinicians) to find out if they are mandated to report under MIPS for the 2018 performance period. This is done through the input of the physician’s National Provider Identifier (NPI), making the process super streamlined and simple. Because the QPP has several requirements and exemptions, updated QPP tools are making navigating the system much more simple.
The QPP lookup tool did not previously reflect 2018 MIPS APM or AAPM information, but CMS now has this available as well as a qualifying APM participant lookup tool. The MIPS Eligibility tool will also inform ECs of special status designations that could affect reporting. For example, if they belonged to a practice with 15 or less ECs or are practicing in an area with a shortage of healthcare professionals. These considerations were not made prior to the updated QPP tools.
Additionally, the CMS has increased the low-volume threshold for 2018 – meaning that there may very well be fewer physicians required to report. Regardless, ECs must report a full year of data for the 2018 performance period to determine if they are required to participate and to make sure that the correct information is being collected.
If you have questions about the updated QPP tools and how it will affect your practice, please contact the professionals at Health Information Services (HIS). We are skilled in teaching practices how to properly utilize these tools to maintain compliance with all applicable laws and regulations. We look forward to speaking with you.