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The Centers for Medicare and Medicaid Services (CMS) updates the rules and requirements for the Quality Payment Program (QPP) annually. Many of the 2019 changes pertain to the Merit-based Incentive Payment System (MIPS) track.

MIPS Track Changes

  • You meet the criteria for a low-volume threshold exemption for the 2019 performance year if you:
    • care for 200 or fewer Medicare Part B patients, submit $90,000 or less in Medicare Part B charges for covered professional services, or provide 200 or fewer Part B covered professional services
      • Individuals or groups who meet or exceed all three of the above criteria are required to participate in MIPS.
      • Those who meet or exceed one or two of the above criteria can choose to opt in to fully participate in the MIPS program. If a clinician or group chooses to opt in, they will be scored and receive a payment adjustment according to their performance during the 2019 performance year.
  • Cost performance will be measured in 2019 and will contribute a larger amount to the overall final score.
  • There is a new scoring methodology for the performing interoperability performance category.
  • Quality performance will contribute a smaller amount to the overall final score.
  • Completion of the Safety Certification in Outpatient Practice Excellence for Women's Health (SCOPE) will count as the completion of one improvement activity as of 2019.
  • The performance threshold to avoid a negative payment adjustment increased from 15 points to 30 points.
  • Facility-based clinicians can use their hospital's performance under the hospital Value-Based Purchasing (VBP) Program for their MIPS Quality and Cost performance categories.
  • Bonus points will be available for small practices, but the six-point bonus score will be applied to the score for the Quality performance category, instead of the overall MIPS score.
  • Bonus points will be available for eligible clinicians and practices who care for complex patients.

Advanced Alternative Payment Model Track Changes

  • The all-payer combination option is now implemented.
  • Obstetrician–gynecologists and other health care professionals may be able to qualify for the 5% bonus by participating in Medicaid and commercial alternative payment models in addition to Medicare models.

Natural Disaster Emergency Regulations

The CMS released emergency regulations for individual clinicians affected by natural disasters, including Hurricanes Harvey, Irma, Maria, and Nate and the California wildfires during 2017. Individual clinicians who practice in certain affected regions were automatically exempt from reporting measures or activities for 2017 and did not receive a negative payment adjustment in payment year 2019. Group practices were not eligible for this accommodation. Visit the QPP website for more information about the emergency regulations and eligibility requirements for those affected by Hurricanes Florence and Michael and the California wildfires during the 2018 performance year. When they released requirements for the 2019 performance year, CMS indicated that this policy would remain the same.

2017 Performance Year Results

The QPP began in January 2017. Final scores and feedback for physicians who were not exempt from MIPS during the 2017 performance year are now available through the QPP website. Those physicians received their MIPS payment adjustments in January 2019.