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Quality Payment Program

Modernizing Medicare to provide better care and smarter
spending for a healthier America.

physician sitting down with and speaking to patient

What's the Quality Payment Program?

The Quality Payment Program improves Medicare by helping you focus on care quality and the one thing that matters most — making patients healthier. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, which threatened clinicians participating in Medicare with potential payment cliffs for 13 years. If you participate in Medicare Part B, you are part of the dedicated team of clinicians who serve more than 55 million of the country’s most vulnerable Americans, and the Quality Payment Program will provide new tools and resources to help you give your patients the best possible care. You can choose how you want to participate based on your practice size, specialty, location, or patient population.

The Quality Payment Program has two tracks you can choose:

  • Advanced Alternative Payment Models (APMs) or
  • The Merit-based Incentive Payment System (MIPS)

If you decide to participate in an Advanced APM, through Medicare Part B you may earn an incentive payment for participating in an innovative payment model.

If you decide to participate in MIPS, you will earn a performance-based payment adjustment.

Who's in the Quality Payment Program?

You’re a part of the Quality Payment Program in 2017 if you are in an Advanced APM or if you bill Medicare more than $30,000 in Part B allowed charges a year and provide care for more than 100 Medicare patients a year. You must both meet the minimum billing and the number of patients to be in the program. If you are below either, you are not in the program.

For MIPS, you must also be a:

  • Physician
  • Physician assistant
  • Nurse practitioner
  • Clinical nurse specialist
  • Certified registered nurse anesthetist

If 2017 is your first year participating in Medicare, then you’re not in the MIPS track of the Quality Payment Program.

Performance:

The first performance period opens January 1, 2017 and closes December 31, 2017. During 2017, record quality data and how you used technology to support your practice. If an Advanced APM fits your practice, then you can join and provide care during the year through that model.

Send in performance data:

To potentially earn a positive payment adjustment under MIPS, send in data about the care you provided and how your practice used technology in 2017 to MIPS by the deadline, March 31, 2018. In order to earn the 5% incentive payment by significantly participating in an Advanced APM, just send quality data through your Advanced APM.

Feedback:

Medicare gives you feedback about your performance after you send your data.

Payment:

You may earn a positive MIPS payment adjustment for 2019 if you submit 2017 data by March 31, 2018. If you participate in an Advanced APM in 2017, then you may earn a 5% incentive payment in 2019.

When does the Quality Payment Program start?

You get to pick your pace for the Quality Payment Program. If you're ready, you can begin January 1, 2017 and start collecting your performance data. If you're not ready on January 1, you can choose to start anytime between January 1 and October 2, 2017. Whenever you choose to start, you'll need to send in your performance data by March 31, 2018. You can also begin participating in an Advanced APM.

The first payment adjustments based on performance go into effect on January 1, 2019.

January 1 to October 2

How will the Quality Payment Program change my Medicare payments?

Depending on the data you submit by March 31, 2018, your 2019 Medicare payments will be adjusted up, down, or not at all. The information provided below is only relevant for the 2019 payment year. CMS will provide additional information on payment adjustments for 2020 and beyond beginning next year.

Pick Your Pace in MIPS

If you choose the MIPS path of the Quality Payment Program, you have three options.

MIPS Plus and Minus Payment Timeline

Not participating in the Quality Payment Program:

If you don’t send in any 2017 data, then you receive a negative 4% payment adjustment.

Test:

If you submit a minimum amount of 2017 data to Medicare (for example, one quality measure or one improvement activity for any point in 2017), you can avoid a downward payment adjustment.

Partial:

If you submit 90 days of 2017 data to Medicare, you may earn a neutral or positive payment adjustment and may even earn the max adjustment.

Full:

If you submit a full year of 2017 data to Medicare, you may earn a positive payment adjustment.

The MIPS payment adjustment is based on the data submitted. The best way to get the maximum MIPS payment adjustment is to participate full year. By participating the full year, you have the most measures to pick from to submit, more reliable data submissions, and the ability to get bonus points.

  • But if you only report 90 days, you could still earn the maximum adjustment—there is nothing built into the program that automatically gives a reporter a lower score for 90-day reporting.
  • Pick the pace that’s best for your practice.
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Participate in the Advanced APM path:

If you receive 25% of Medicare payments or see 20% of your Medicare patients through an Advanced APM in 2017, then you earn a 5% incentive payment in 2019.

The cycle of the program looks like this:

Forward together


We're working together towards a big goal, so we're starting slow. We are listening and want your input on how to improve the Quality Payment Program.

As the program grows, so does the possibility to be rewarded for providing better care. These kinds of smarter payments give you more time to spend with your patients and to care for them in the way you think is best.

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