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Quality Payment Overview


Quality Payment Program

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Quality Payment Overview


Quality Payment Program

quality Payment program

The Quality Payment Program was designed to tie payments to quality and cost efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care. As such, CMS has implemented a quality payment incentive program, referred to as the Quality Payment Program, which rewards value and outcomes in one of two ways: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). The end result is better care, plus smarter spending, for a healthier America.

Based on your practice size, specialty, location, or patient population, you have two tracks from which to choose. Performance is measured through the data clinicians report in four areas - Quality, Improvement Activities, Promoting Interoperability (formerly Advancing Care Information), and Cost.

The following represent the two ways clinicians can choose to participate in the Quality Payment Program:


MIPs and APM

Merit-Based Incentive Payment System

Under MIPS, clinicians are included if they are an eligible clinician type and meet the low volume threshold, which is based on allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS) and the number of Medicare Part B patients who are furnished covered professional services under the Medicare Physician Fee Schedule. If you’re a MIPS eligible clinician, you’ll be subject to a performance-based payment adjustment through MIPS.


APM CMS Program

Alternative Payment Model

An APM is a customized payment approach developed by CMS, often designed to provide incentives to clinicians who are providing high-quality, high value care. APMs can focus on specific clinical conditions, care episodes, or populations. If you decide to take part in an Advanced APM, you may earn a Medicare incentive payment for sufficiently participating in an innovative payment model.