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Welcome to the Quality Payment Program (QPP) resources page where you’ll find useful information on the QPP. Under the MACRA law, the Centers for Medicare and Medicaid Services (CMS) was required to create and maintain the QPP and its two payment tracks: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).
It is essential for providers to understand the QPP rules and eligibility and how payment adjustments (positive or negative) may apply to performance in the program.
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Clinicians are eligible for MIPS if they are one of the identified clinician types and meet the Medicare volume threshold based on:
- Medicare-allowed charges for covered professional services
- The number of Medicare Part B beneficiaries who are furnished covered
- Professional services
MIPS-eligible clinicians will receive a positive or negative payment adjustment based on benchmarked performance in all four (4) MIPS performance categories. Eligible clinicians choosing not to participate in MIPS will receive the full negative payment adjustment (penalty) under the MACRA law and QPP rules.
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The Four MIPS Performance Categories
NextGen Configuration for MIPS
MIPS Data & Validation Audits (DVA)
If you receive a MIPS audit notification from CMS contractor Guidehouse, you must respond in a timely manner with the information requested. This information should be obtainable using the following:
- HQM reports
- Client’s internal audit documentation saved to their audit binder
- Chart pulls (similar to Medicare RAC audits)
If the auditor demands for a “vendor letter” or “CEHRT letter”, follow the same process for DVA as for MU audits, outlined below.
Additional information about MIPS DVA can be found on the CMS QPP Resource Library.
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MIPS-eligible clinicians who meet the volume threshold under one of the APMs identified by CMS earn a 5% incentive in addition to any accrued APC-specific benefits in addition to earning an exclusion from MIPS.
Providers participating not meeting advanced APMs threshold or participating in a "MIPS APM" may qualify to use the AMP MIPS scoring standard while participating in MIPS.
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| | |  | Primary Care First
Primary Care First is a voluntary alternative five-year payment model that rewards value and quality by offering an innovative payment structure to support the delivery of advanced primary care. In response to input from primary care clinician stakeholders, Primary Care First is based on the principles underlying the existing Comprehensive Primary Care Plus (CPC+) model design: prioritizing the clinician-patient relationship; enhancing care for patients with complex chronic needs, and focusing financial incentives on improved health outcomes.
| | | |  | Accountable Care Organizations (ACOs) (NextGen Enterprise Only)
ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.
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NextGen Healthcare Value-Based Care Resources
** If you're looking for Medicaid Promoting Interoperability Measures, click here. |
External Resources
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Return to: Regulatory and Value-Based Programs |
