Updates to the Quality Payment Program

Educate Your Patients into Action
ICD-10-CM Updates for 2018

On November 16, 2017, the Centers for Medicare and Medicaid Services (CMS) is expected to publish the final rule to address updates to the Quality Payment Program (QPP).  The new “Patients Over Paperwork” initiative provides for streamlining with goals of reducing unnecessary burden, increasing efficiencies, and improving the beneficiary experience. This effort emphasizes a commitment to removing regulatory obstacles that get in the way of providers spending time with patients.

CMS provides updates for the second year of QPP to provide more flexibility during 2018 and addresses extreme and uncontrollable circumstances, such as hurricanes and other natural disasters, for both the transition year and the 2018 MIPS performance period. Here are some of the most significant changes for small providers participating in MIPS:

  1. More small providers will fall under the exemption category with an increased threshold. The low volume threshold of $30,000 in Medicare Part B charges or 100 Medicare Part B patients will increase to a threshold of $90,000 or less in Medicare Part B charges or 200 patients annually.  
  2. New reporting options for hospital based physicians and solos and small groups. Hospital based doctors will be able to report on quality and cost in the facilities where they work.  Their individual score will be calculated with the submission of the facility’s inpatient value-based score.  
  3. New virtual groups allow solo practitioners and groups with fewer than 10 eligible providers to combine for a performance period of a year.  Virtual Groups would be composed of solo practitioners and groups of 10 or fewer eligible clinicians who come together “virtually” with at least 1 other such solo practitioner or group to participate in MIPS for a performance period. Please note: the group would have to be assessed as a group on all MIPS categories.
  4. Meaningful Use is replaced by Advancing Care Information (ACI) and allowing the 2014 edition of CEHRT for the 2018 calculations. However, a bonus will be issued in the category of ACI for use of certified 2015 edition EHR.
  5. Cost will not be a weighted category for 2018, but it is recommended to increase efforts in this area as cost scoring is still a category to be added in the future. For now, quality will remain the most heavily weighted category at 60% with more quality measures added.
  6. Bonus points will be awarded by CMS for the following factors: caring for complex patients, and being part of a practice with fewer than 15 providers

For more helpful information about MACRA and MIPS, please download our eBook and register for our upcoming complimentary webinar.

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