decisionhealth Newsletters, Coder Pink Sheets - 2016 Issue 11 (November)
Quality reporting: QPP final rule creates a 2017 ‘transition year,’ lower reporting thresholds
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Article Overview
This article covers CMS’s final rule for the Quality Payment Program (QPP) and describes how the first performance year is being treated as a transition period. It outlines the broad structure of the Merit-based Incentive Payment System (MIPS) and advanced Alternative Payment Models (APMs), summarizes the lowered participation and reporting thresholds for 2017, and explains how the program’s major categories and payment adjustment framework are being rolled out. The piece is relevant for physicians, clinician groups, and coding or reimbursement professionals who need to understand federal quality reporting requirements and how the new program compares with prior reporting initiatives.
Why This Topic Matters
The article highlights early-year QPP policies that affect whether clinicians face payment adjustments and how much reporting is needed to participate. Understanding these transition rules is important for planning quality reporting, avoiding penalties, and tracking how CMS is phasing in the new Medicare payment model.
Article Sections
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Transition year policies for 2017
Overview of the first year of the Quality Payment Program and the general approach CMS is taking for the initial transition period. Covers participation flexibility and the broader purpose of the ramp-up period.
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Note relaxed thresholds to avoid negative payments
Summary of the 2017 participation and reporting thresholds under MIPS and the related payment adjustment framework. Also addresses the general treatment of exceptional performance and advanced APM participation.
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New MIPS formula removes cost score
Description of the main MIPS categories and how the program is structured relative to earlier reporting programs. Includes the high-level weighting of the categories and the basic participation scope for the program.
What You Will Learn
- How CMS is framing the first year of the Quality Payment Program
- What broad participation options exist during the transition period
- How MIPS is organized into its major reporting categories
- How advanced APM participation fits into the new quality reporting framework
- What general thresholds CMS is using to phase in the program
Who Should Read This
- Physicians
- Clinicians participating in Medicare quality reporting
- Medical practice administrators
- Revenue cycle and reimbursement staff
- Health policy and compliance professionals
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