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Quality Payment Program: ISMS Boils Down CMS’ 1600-Page Final Rule to 5 Key Points
Posted on: 11/7/2017

Ready or not, the Centers for Medicare and Medicaid Services (CMS) has released the final rule for its Quality Payment Program (QPP).

The rule is over 1,600 pages long, and ISMS has identified several key points physicians need to know now:  

  1. The low volume threshold has increased. Physicians who see fewer than 200 Medicare Part B patients or bill less than $90K in Part B charges are excluded from the Merit-based Incentive Payment System (MIPS).

  2. Practices participating in MIPS must earn at least 15 points in order to avoid a 5 percent payment penalty in 2020. Practices can earn points in a variety of ways, and more points means more opportunity to earn an incentive.

  3. New bonus opportunities and exceptions have been added for "small practices," defined as practices with 15 or fewer eligible clinicians.

  4. Groups of 10 or fewer eligible clinicians and solo practitioners can join together with other such groups to form a "virtual group" for the purpose of MIPS reporting.

  5. Total MIPS scores are based on the weighted average of four categories: quality (50 percent); improvement activities (15 percent); advancing care information (25 percent); and cost (10 percent). 2018 will be the first performance year for which MIPS includes the cost category in the final scoring.

ISMS will be providing more information and materials to help you understand your responsibilities for 2018 and keep you informed as additional information becomes available.

For a comprehensive summary, check out Medicare's Quality Payment Program Year 2 fact sheet, which includes a summary comparing 2017 and 2018 MIPS participation rules.

In the meantime, the ISMS advocacy team is standing by to answer your questions. Contact us at 800-782-4767 ext. 1470, or send an email.

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