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Determine Your Status under the Medicare Quality Payment Program

Since Medicare published the final regulations on the Quality Payment Program, several changes have been made and some things have been clarified. Here’s a review of those changes:

Threshold changes

Physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists are eligible to participate in the Medicare quality payment program, which includes the Merit Based Incentive Payment System (MIPS), if:

  • More than $30,000 is billed to Medicare or care is provided to more than 100 Medicare patients per year.

You can be exempt from the quality payment program:

  • If 2017 is your first year participating in Medicare, you are exempt from participation in the quality payment program
  • If you opted to participate in an Alternative Payment Model, you are exempt from MIPS

The quality payment program creates a composite performance score based on four weighted performance categories: Cost, Clinical Practice Improvement, Advancing Care and Quality.

  • Physicians who do not interact directly (face-to-face) with patients (radiologists, etc.) may get a break from being scored in the advancing care information category. For example, if a radiologist bills 100 or fewer patient encounters (including Medicare telehealth services) from Sept. 1, 2015, to Aug. 31, 2016, and Sept. 1, 2016, to Aug. 31, 2017, the advancing care information category changes from a score of 25 percent to zero.
  • The cost category worth 10 percent of the composite score is zero for 2017, which means physicians do not need to worry about this category until 2018.

Read more on the “patient-facing” encounter codes and the quality payment program.

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