Jan. 1, 2017, marked the opening period for the Quality Payment Program, established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program aims to promote value-based care over a fee-for-service system and is projected to have a significant impact on how providers are reimbursed by the Centers for Medicare & Medicaid Services (CMS). The Quality Payment Program provides performance incentives for participation in one of two tracks: the Merit-based Incentive System (MIPS) or a recognized Advanced Payment Model (APM).
CMS has developed an interactive tool to help providers determine their MIPS participation status by entering their National Provider Identifier (NPI) in the search field. The site will then indicate whether or not clinicians are required to participate in MIPS and will provide additional resources. The two criteria for participating in MIPS are:
- Bill more than $30,000 in Medicare Part B allowed charges per year; and
- Provide care for more than 100 Part B-enrolled Medicare beneficiaries per year
Eligible clinicians include physicians (MD/DO and DMD/DDS), physician assistants, clinical nurse specialists, and certified registered nurse anesthetists. Providers who are not required to participate in the program also may submit data voluntarily in order to obtain feedback from CMS and prepare for a possible expansion of the program in the future.
Payment adjustments based on performance for the 2017 transitional year will go into effect Jan. 1, 2019. Clinicians can stay informed about developments within the program by subscribing to the CMS Quality Payment Program listserv, which provides information including:
- Educational resources and interactive tools
- Important dates and deadlines
- CMS webinars and announcements
To subscribe to the listserv, navigate to the Quality Payment Program and click “Subscribe to Updates” at the bottom of the page.
Additional resources are available at the Payment Reform page of the Evolve Sleep website, including a MACRA webinar that provides more details about the Quality Payment Program.
