Quality Payment Program

Why This Topic Matters

QPP affects Medicare reimbursement and participation requirements for many clinicians and groups. Understanding the program’s structure, affected provider types, and major reporting pathways is important for planning compliance and anticipating payment impacts.

Article Sections

1. History of the QPP: The SGR and quality reporting

   Covers the policy background leading up to QPP, including earlier Medicare cost-control efforts and prior quality reporting initiatives. Also summarizes how those earlier programs shaped the new framework.

2. Who does and doesn’t do QPP

   Describes which Medicare Part B clinicians are generally subject to the program and which situations are excluded. Also introduces the distinction between advanced APM participation and MIPS participation.

3. QPP reporting method one: MIPS

   Explains the main MIPS pathway, its broad performance categories, and how reporting is organized at a high level. Includes transitional-year context and general scoring concepts.

4. Transitional year(s)

   Summarizes the reduced first-year requirements and the general approach CMS used for the initial implementation period. Also notes the broad reporting expectations by category.

5. Quality

   Describes the quality category within MIPS, including general reporting expectations, special cases, and specialty measure set considerations. Also discusses how reporting format can affect measure selection.

6. Advancing Care Information

   Covers the electronic health record-related MIPS category and the general types of measures and bonus opportunities associated with it. The section focuses on the category’s role in the overall scoring framework.

7. Improvement Activities

   Explains the improvement activities category and how it fits into MIPS scoring. Also summarizes general special-case treatment for certain practices and APM participants.

8. Resource Use

   Outlines the resource use category and its role in the 2017 program year. Notes the shift away from provider-reported data in future years.

9. Specialty Measure Sets

   Describes how specialty-specific measure sets are used to help clinicians identify relevant quality measures. Also distinguishes these sets from earlier program groupings.

10. Reporting and scoring

    Explains the general ways clinicians and groups can submit data and how MIPS performance is aggregated for scoring. Also covers broad data submission channels and the relationship between reporting and payment adjustment.

11. As a group

    Addresses group-level submission and scoring under MIPS. Also notes the general definition of a group and group-based reporting channels.

12. What data do you report?

    Summarizes the kinds of data that may be reported and the general reporting basis for different submission methods. Also describes the use of numerator/denominator style reporting and attestation at a high level.

13. How is the data scored?

    Covers the general scoring framework, category weighting, thresholds, and the overall relationship between points and payment adjustments. Also explains the presence of bonus-style scoring elements at a high level.

14. MIPS APMs

    Explains how certain alternative payment models are treated within the MIPS structure. Also introduces the criteria used to identify MIPS APMs and the special scoring framework that can apply.

15. Special MIPS scoring

    Describes how scoring is handled for clinicians participating in MIPS APM entities. Focuses on the aggregated nature of scoring and its effect on payment adjustment.

16. QPP reporting method 2: Advanced APM

    Introduces the advanced APM pathway under QPP and its relationship to MIPS exemption and incentive eligibility. Also outlines the general criteria used to identify advanced APMs.

17. QPs and Partial QPs

    Explains the general concepts of qualifying APM participant status and partial qualifying status. Also describes the broad implications for reporting obligations and incentive eligibility.