Merit-Based Incentive Program System/Quality Payment Program

The Centers for Medicare and Medicaid Services created the Quality Payment Program based on MACRA legislation.  QPP provides penalties and incentive payments based on your Merit-Based Incentive Payment System (MIPS) scores. It incorporates the pre-existing value-based programs below and a new quality program, "Clinical Practice Improvement," into 4 performance categories.  Higher performance in each category will result in higher MIPS scores and a greater chance of avoiding penalties and earning larger incenives.

  1. Quality: Based onPQRS (60% of your overal 2017 MIPS Score)
  2. Clinical Practice Improvement:  This is new! Think about your role in overall public health. (15% of your overal 2017 MIPS Score)
  3. Advancing Care Information: Based on Meaningful Use! (25% of your overal 2017 MIPS Score)
  4. Resource Use/Cost: Based on the Value-Based Modifier. (0% of your overal 2017 MIPS Score).  

Quality ACI Final Score

AVOIDING 2018 PENALTIES BASED ON 2017 PERFORMANCE

You can be excluded from QPP and avoid future penalties if at least ONE of the following applies to you (See AOA's Know your Exclusions for more details):

  • 2017 is your first year submitting claims to Medicare;
  • Your Medicare billing charges are less than or equal to $30,000;
  • You provide care for 100 or fewer Part B-enrolled Medicare beneficiaries; or
  • You are a Qualifying APM Participants (QP) and Partial Qualifying APM Participant (Partial QP).       

If none of above conditions apply, you can avoid a 4% penalty (reduction) in your 2018 Medicare Payments by performing at least ONE of the following options in 2017:

EARNING 2018 INCENTIVES BASED ON 2017 PERFORMANCE

Up to a 4% incentive (increase) in 2018 Medicare payments can be earned based on the level of 2017 participation and MIPS score.  For more information on scoring, penalties, and incentives see AOA's

Additional Resources: