Quality Payment Program

The Quality Payment Program Year 2 – 2018

The Medicare Access and CHIP Reauthorization Act (MACRA) establishes the Quality Payment Program (QPP) for eligible professionals. It is the second year of this program. QPP 2018 is here to accomplish three fundamental goals.

  • Enhanced Care
  • Intelligent Spending
  • Healthier Society

According to QPP, the eligible clinicians can choose to perform on any one of the two tracks.

  1. Merit-based Incentive Payment System (MIPS)
  2. Advanced Alternative Payment Models (Advanced APMs)

Moving from 2017 to 2018, both the tracks have undergone significant changes.

Merit-based Incentive Payment System (MIPS) 2018

The purpose of MIPS is to focus on the importance of value-based care over volume-based treatments. It also recaptures the idea of improved patient outcomes. CMS requires reports and data submissions to know precisely the status of care delivery in your practice.

MIPS combine previous programs along with a new program with minor changes

  1. Quality (Formerly Physician Quality Reporting System)
  2. Promoting Interoperability (Formerly Advancing Care Information/Meaningful Use of EHR)
  3. Cost (Formerly Value-Based Modifier)
  4. Improvement Activities (New component introduced in 2017)

Eligibility Criteria for MIPS 2018

To stand eligible for participation in MIPS 2018, one must fall in the correct ‘clinician type’ category. Secondly, one should meet the low-volume threshold requirement.

Types of Eligible Clinicians –

  • Primary Care Physicians and Physician Specialists (billing Medicare)
  • Physician Assistants (PAs)
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists

You must be one of the above to qualify for MIPS 2018.

Updated Low-Volume Threshold Requirement –

For MIPS 2018, the eligibility benchmark has exceeded.

You are eligible for MIPS 2018 if you had –

  • Provided care to more than 200 Medicare Part B patients in the last year.
  • And billed $90,000 or more for Medicare Part B patients

You are exempt –

  • If you are newly enrolled in Medicare and 2018 is your first year of providing care to Medicare patients
  • If you don’t fall in the above criteria (type and low-volume threshold)
  • If you decide to participate in an Advanced APM

Category Changes for 2018


  • Carries 50% weight in the MIPS Final Score
  • Report 6 quality measures, one should be an outcome measure, if there is no outcome measure to report, you must report a high-priority measure.
Report quality for the full year:

Quality will be reported for an entire year. You need to submit data for at least 60% or more patients (The measures must meet the data completeness attribute for more points otherwise each of them will receive only 3 points)


  • It is a new category and holds 10% of the MIPS Final Score.
  • There is no reporting method required for this category, CMS will evaluate your billing claims for 2018 (January 1stto December 31st, 2018) to calculate the score for this category.
  • You can download QRUR (Quality Resource Use report) of the previous year to find out areas of improvement in Cost.

Promoting Interoperability (Formerly Advancing Care Information)

  • Carries 25% weight of the MIPS Final Score
  • You may use the 2014 or 2015 version of certified EHR for MIPS PI in 2018.
  • Must report on all the base measures to successfully report PI (Promoting Interoperability).
  • Report performance and bonus measures for extra points.
  • Report for at least consecutive 90 days or full year

Improvement Activities

  • Carries 15% weight of the MIPS Final Score
  • You have to implement and report activities worth 40 points for at least consecutive 90 days or full year.

Impact of MIPS 2018 on ECs in 2020

  • If your total MIPS composite score is 15, you will receive neutral payment adjustment on your Medicare Reimbursements (no downward or upward adjustment) in 2020.
  • If your total MIPS composite score is less than 15, you would have a negative 5% payment adjustment on your Medicare reimbursement.
  • If you score above or equal to 70, you will get a positive 5x budget-neutral incentive in the year 2020.
  • Scoring above 70 CPS for MIPS may also make a practice eligible for MIPS bonus payments, which every year are paid out of a $500 million dollar pool for the top 25% performing clinicians.

Submission Methods

You can choose a QCDR, a MIPS Registry, EHR system, or CMS web interface (for groups of 25 ECs or more) to report on these performance categories. However, you must choose a single method of reporting for each category.

How to qualify for additional bonuses?

  • Improve your MIPS composite score by improving your performance for each of the MIPS components.
  • For Cost category, making significant changes in care delivery to cut down costs can earn you up to 1% extra point.
  • ECs and groups gain up to 5 points for treating the complex patients.
  • If ECs or groups are part of small practices, they will be awarded 5 bonus points

Advanced Alternative Payment Modules (APMs) for 2018

Advanced APMs is the second track of the Quality Payment Program, which you can opt out by meeting the eligibility criteria.

An APM is a payment system that rewards incentives on account of superior-quality and money-saving care.

How can you benefit from an Advanced APM?

Once you’re attested to and start participating in an Advanced APM in 2018, you are eligible for incentive payments of up to 5% in 2020.

Eligibility Requirements for Participation

You must:

  • Receive 25% of your Medicare Part B payments through an Advanced APM
  • You must be treating 20% of your Medicare Part B patients through an Advanced APM

The APM model’s portal will guide you through the process of reporting quality category’s data to CMS effectively. If you decide to leave this track in the ongoing performance period of 2018, you must ensure you have received enough payments or treated enough patients through an Advanced APM to be eligible for 5% positive payment adjustments in 2020. If you don’t meet the minimum requirements of the Advanced APM, you have to join the MIPS 2018 track to prevent -5% deductions from your annual Medicare income in 2020.


Reputational Impacts

CMS publishes sets of clinician-identifiable performance measures through the Physician Compare website and third-party physician-rating websites to acquire for free. With a more digitally aware consumer population, this data will have more informed patients and encourage fair competition among practitioners to deliver superior service.

Virtual Groups vs. Individual Participation

Now eligible professionals can participate in MIPS 2018 in the form of virtual groups.

Reporting as individuals or as groups (under one TIN) is similar to 2017.

P3Care – Optimizing Your Performance

With a long-running experience on Medicare Part B Quality Reporting, seasoned P3 analysts and consultants provide more than just a helping hand. We take control of your demonstration from day one and make sure staff time, and physician time is saved through-out the program’s demonstration.

2018 MIPS Qualified Registry

CMS recognizes P3 Healthcare Solutions as a MIPS Qualified Registry for the year 2018. We are authorized to report on all Quality Measures, Promoting Interoperability, and/or Improvement Activities on behalf of MIPS participants in the form of individuals, groups, or virtual groups.

Performance Category

Weightage in 2017Weightage in 2018
Promoting Interoperability (ACI)25%25%
Improvement Activities15%15%

P3Care was MIPS Registry in 2017, and now is in 2018, we are approved to report data to CMS once again. For questions out of this service, or on instructions on how to get started call a medical billing service expert today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com