BC Advantage - 2017 Issue 5
To QP, or Not to QP: Is That the Question?
Subscribe or sign in to view the full article.
Article Overview
This article discusses how CMS defines and evaluates Qualifying Participant status for Advanced Alternative Payment Model participation under the Quality Payment Program. It is written for clinicians and administrators involved in ESCOs or other Advanced APMs, especially those in nephrology, and it covers the general structure of the eligibility calculation, timing of CMS determinations, and the broader implications for MIPS participation and bonus eligibility.
Why This Topic Matters
Understanding QP determination is important for Advanced APM participants because it affects whether clinicians are excluded from MIPS and whether they may qualify for related payment incentives. The article is relevant to organizations and practices trying to assess participation readiness and expected program impact.
Article Sections
-
Introduction to the QP determination issue
Sets up the CMS policy update and explains why the topic matters for Advanced APM participants, particularly those involved in nephrology-focused models.
-
Advanced APM participation and program context
Reviews the relationship between the Quality Payment Program, MIPS, and Advanced APM participation, with emphasis on ESCOs and participant incentives.
-
How CMS defines the QP calculation
Describes the overall framework CMS uses to determine QP status and outlines the general components of the patient-based calculation.
-
Denominator criteria and evaluation timing
Summarizes the categories CMS uses when identifying the patient population evaluated for QP determination and notes the timing of periodic checks.
-
Implications for ESCO participants
Explains the practical significance of the QP determination for ESCO participants and the potential program effects tied to that status.
What You Will Learn
- How CMS approaches QP status determination for Advanced APM participants
- Why ESCO participation is central to the article's discussion
- What broad categories of patient eligibility are considered in the calculation
- When CMS reviews the calculation during the performance year
- How QP status affects participation in the Quality Payment Program
Who Should Read This
- Nephrologists
- ESCO participants
- Advanced APM participants
- Health system and practice administrators
- Medical coders and reimbursement staff following MACRA/QPP policy
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com