Required Changes Impacting Your Practice

On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule of the Quality Payment Program that is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program improves Medicare by providing new tools and resources that help you focus on care quality and the one thing that matters most — making patients healthier. If you participate in Medicare, the Quality Payment Program is for you!

In the Quality Payment Program you earn a payment adjustment based on evidence-based and practice-specific quality data. You show you provided high quality, efficient care supported by technology by submitting data to CMS in the following categories:



Improvement Activities

Improved Activities

Promoting Interoperability

Advance Care Information



Choosing Your Method of Participation

You choose how to participate in the Quality Payment Program based on your practice size, specialty, location, or patient population; you must choose one of two tracks: The Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). You are eligible to participate in the MIPS track if you bill more than $90,000 to Medicare, provide care to more than 200 Medicare patients per year, provide more than 200 covered professional services under the Physician Fee Schedule and you are a: Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, Clinical Psychologist, Physical Therapist, Occupational Therapist, Speech-Language Pathologist, Audiologist, Registered Dietician or a Nutrition Professional.

An APM is a payment approach that can apply to a specific clinical condition, a care episode, or a population that gives added incentive payments to provide high-quality and cost-efficient care. Advanced APMs are a subset of APMs and let practices earn more for taking on some risk related to patients’ outcomes. You may earn a 5% Medicare incentive payment and be exempt from MIPS reporting requirements and payment adjustments if you have sufficient participation in an Advanced APM. Some current Advanced APM options include Medicare Shared Savings ACOs Tracks 1+, 2 & 3, Next Generation ACOs, and Comprehensive Primary Care Plus (CPC+). In order to qualify for the 5% APM incentive payment for participating in an Advanced APM during a payment year, you must either meet a percentage threshold of payments for covered professional services on attribution-eligible Part B beneficiaries or see a certain percentage of attribution-eligible beneficiaries through the Advanced APM during the associated performance year.

Supporting Clinicians in the Midwest

Our Quality Payment Program Resource Center® is a groundbreaking collaboration among 10 key partners across seven states in the Midwest designed to transform the way health care is administered to patients by supporting providers like you in small practices in rural or underserved areas. Backed by funding from the Centers for Medicaid and Medicare Services (CMS), the Quality Payment Program Resource Center® for the Midwest aims to deliver needed support to 35,000+ clinicians as they prepare to provide high-quality care at a reasonable cost under MACRA legislation.

Simply complete our Contact Us form and one of our knowledgeable Quality Payment Program Advisors will give you a call. Once we understand your starting point, our Team can get to work providing the support you need for transformation success! Are you unsure if you're in the Midwest region or need help finding who you can talk to about the Quality Payment Program? Complete our Contact Us form and we will help point you in the right direction.