Background Resources

Background Resources

QPP Overview

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed the way physicians are reimbursed for Medicare Part B services beginning January 1, 2017. MACRA repealed the sustainable growth rate (SGR) formula and replaced it with a new program—the Quality Payment Program (QPP)—under which clinicians will have the opportunity to earn bonuses, or face penalties, in the form of positive, neutral, or negative adjustments based on their performance in quality and cost measures. This resource provides a brief overview of the two participation pathways under the QPP. 

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Comprehensive Overview on the QPP (slide deck)

This tutorial provides an overview of the MACRA Quality Payment Program (QPP) and an overview of the MIPS pathway, including the MIPS categories, participation eligibility and exemptions, reporting mechanisms, and 2017 transition year minimum reporting options. 

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Guide to Acronymns

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed the way physicians are reimbursed for Medicare Part B services beginning January 1, 2017. MACRA repealed the sustainable growth rate (SGR) formula and replaced it with a new program—the Quality Payment Program (QPP)—under which clinicians will have the opportunity to earn bonuses, or face penalties, in the form of positive, neutral, or negative adjustments based on their performance in quality and cost measures. This resource provides a guide to the acronyms utilized within the context of the QPP. 

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Reporting Mechanisms

Under MACRA’s Quality Payment Program (QPP), physicians may choose to participate in an Advanced Alternative Payment Model (APM) or submit data to the Merit-Based Incentive Payment System (MIPS). MIPS is a new program that consolidates and sunsets the previous quality reporting programs, including the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VM), and the Electronic Health Records (EHR) Incentive program (Meaningful Use), into one program. In 2017, MIPS has four weighted performance categories: quality (60%), based on PQRS; cost (0%), based on VM; advancing care information (25%), based on Meaningful Use; and improvement activities (15%), a new category not based on a previous program. This resource provides guidance on the different MIPS reporting mechanisms available. 

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How QPP Affects Medicare Part B Payments

Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Centers for Medicare and Medicaid Services (CMS) designed a new Quality Payment Program (QPP) that has two payment pathways: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). The QPP is an annual program and each calendar year is referred to as a performance year, which affects your Medicare Part B fee-for-service (FFS) payments two years later. This resource provides an overview of how your Medicare Part B FFS payments are affected, which depends on which of the two paths—MIPS or Advanced APMs—you select for QPP participation. 

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Diagram/Landscape of Key Resources and Organizations

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed the way physicians are reimbursed for Medicare Part B services beginning January 1, 2017. MACRA repealed the sustainable growth rate (SGR) formula and replaced it with a new program—the Quality Payment Program (QPP)—under which clinicians will have the opportunity to earn bonuses, or face penalties, in the form of positive, neutral, or negative adjustments based on their performance in quality and cost measures. This resource provides a guide to key resources and organizations across the country, which can assist you with participation in the QPP. 

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