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Support and Available Options for Small, Underserved, and Rural Practices

Get the help you need to participate and succeed in the Quality Payment Program (QPP)

Clinicians in small practices, including those in rural locations, health professional shortage areas, and medically underserved areas are a vital part of our healthcare system. You provide critical services and access to health care for many Medicare patients. CMS provides flexible options to help you actively participate in the Quality Payment Program.

Technical Assistance for Small, Underserved, and Rural Practices

To help get you started, we have launched the Small, Underserved, and Rural Support initiative to provide free, customized technical assistance to clinicians in small practices. This five-year program was funded by the Medicare Access and CHIP Reauthorization Act (MACRA).

This assistance is available to practices with 15 or fewer clinicians. Priority is given to those small practices:

  • Located in a rural area
  • Located in designated health professional shortage areas (HPSAs)
  • Located in designated medically underserved areas (MUAs)

Through this initiative clinicians included in the Quality Payment Program can receive:

Choose and report measures

Help choosing and reporting on quality measures.

Guidance with the program

Direct education and outreach. Guidance with all aspects of the program, including strategic planning and helping your team adapt to the new Quality Payment Program processes.

Support for optimizing health IT

Support for optimizing health information technology, such as Certified Electronic Health Record Technology (CERHT).

Get connected or learn more:

Assistance Providers

These are the organizations we’ve selected to help you achieve your goals. Select your state.

Options for Small Practices

We have also created options within the Merit-based Incentive Payment System (MIPS) for the 2017 Transition Year to reduce the participation and reporting burden for small practices. These include:

  • The ability to pick your pace. If you are included in MIPS, you will be able to pick your pace during the 2017 Transition Year, ranging from submitting a minimal amount of data, to fully reporting.
  • Low Volume Threshold for participation. If you have less than or equal to $30,000 in Medicare Part B allowed charges OR less than or equal to 100 Medicare Part B patients, you will not have to participate in MIPS.
  • 2017 Minimal Participation Requirements. This means that you will need to submit only a small amount of data to avoid a negative payment adjustment.
  • Flexible Data Requirements: Small practices, especially those in rural locations and in health professional shortage areas, are required to report only two (2) activities in the Improvement Activities performance category instead of the four (4) required for larger practices. If you are in a small practice:
    • Medium-weighted activities are worth 20 points of the total Improvement Activity performance category score
    • High-weighted activities are worth 40 points of the total Improvement Activity performance category score
  • Advancing Care Information Performance Category. You may apply to have this category reweighted to zero for the following reasons:
    • Insufficient Internet Connectivity
    • Extremely and Uncontrollable Circumstances
    • Lack of Control over the Availability of CEHRT

We will provide additional tools and resources throughout the 2017 Transition Year to help you determine if these statuses apply to you.

Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs)

You may be exempt from MIPS if you are a part of a Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC). If you bill for Medicare Part B services exclusively through the RHC or FQHC payment methods, then you are not eligible for payment adjustments under MIPS. This is because MIPS does not apply to these facility payments. However, if you are a part of a RHC or FQHC and bill for Medicare Part B services under the Physician Fee Schedule (PFS), then payment for such other services would be subject to the MIPS payment adjustments unless your billings are below the low volume exclusion threshold determination or you meet another exclusion.

If you are practicing in a Critical Access Hospital (CAH) that bills under Method I or Method II AND have not assigned your rights to the facility, then you are eligible to participate in MIPS. The payment adjustment will apply to those Medicare Part B services billed under the PFS only. The MIPS payment adjustment does apply to Method II CAH payments when MIPS eligible clinicians who practice in Method II CAHs have assigned their billing rights to the CAH.