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Support for Small, Underserved, and Rural Practices

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

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 throughout the Performance Year (PY).

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)

2017 Support Details

Types of Support Available

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).

Support Contact Information

Get connected or learn more:

Small, Underserved and Rural Assistance Providers

Choose a state to view contact information for that state’s selected provider.

Options for Small Practices

We have also created options within the Merit-based Incentive Payment System (MIPS) for Performance Year 2017 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 Performance Year 2017, 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

Throughout Performance Year 2017, we will provide additional tools and resources 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.

2018 Support Details

Types of Support Available

Through the Small, Underserved, and Rural Support initiative, clinicians included in the Quality Payment Program can receive both program and practice-level support for Performance Year 2018.

Program Level Support

  • Support in understanding the general requirements of the Quality Payment Program
  • Assistance in determining if you're included in the program
  • Advice on identifying and choosing appropriate MIPS measures and activities to report
  • Help with submitting your data
  • Guidance on transitioning into an Alternative Payment Model (APM) or Advanced APM

Practice Level Support

  • Practice readiness assessments
  • Developing strategies for implementing Certified Electronic Health Record Technology (CEHRT)
  • Assistance in forming partnerships with peers, local stakeholders, regional collaboratives, and more
  • Support in participating in a quality improvement initiative

Support Contact Information

We have selected external assistance providers throughout the country that can help small, underserved, and rural practices participate in the Quality Payment Program.

Small, Underserved and Rural Assistance Providers

Choose a state to view contact information for that state’s selected provider.

You can also get support for your small, underserved, or rural practice using the contact information below:

Options for Small Practices

For Performance Year 2018, we're adding tailored flexibilities for clinicians in small practices, while continuing some of our Performance Year 2017 policies to continue to reduce your burden and prepare you for future program years.

Overall Flexibilities

  • Excluding individual MIPS eligible clinicians or groups with less than or equal to $90,000 in allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS) orless than or equal to 200 Medicare Part B patients who are furnished covered professional services under the Medicare Physician Fee Schedule
  • Giving solo practitioners and small practices the choice to form a virtual group to participate with other practices
  • Adding 5 bonus points to the MIPS final scores of small practices
  • Modestly increasing the performance threshold to 15 points in Performance Year 2018 (from 3 points in Performance Year 2017)

Quality Flexibilities

For Performance Year 2018, we continue to award small practices 3 points for measures in the quality performance category that don't meet data completeness requirements.

Advancing Care Information Flexibilities

For Performance Year 2018, you may continue to use either 2014 or 2015 Edition of Certified EHR Technology (CEHRT). However, a 10% bonus is available if you only use the 2015 Edition CEHRT.

You may continue to apply to have this category reweighted to zero for the following reasons:
  • You're in a small practice (new for PY 2018)
  • You have insufficient internet connectivity
  • You have extreme and uncontrollable circumstances
  • You lack control over your availability to CEHRT

You'll need to submit a hardship application by December 31, 2018 in order to have the advancing care information performance category reweighted to 0%.

Improvement Activities Flexibilities

For Performance Year 2018, the flexible data requirements for the improvement activities performance category remain the same. 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

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

For Performance Year 2018, Our policy for RHCs, FQHCs, and CAHs remains the same from Performance Year 2017.

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.


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