Quality Payment Program Update

By Elizabeth Woodcock, MBA, FACMPE, CPC
June, 2018

Physicians who bill more than $90,000 in total allowed Medicare Part B charges need to ensure successful participation in the Quality Payment Program (QPP). Two pathways are available: submitting data for the Merit-based Incentive Payment System (MIPS) or joining an Advanced Alternative Payment Model (APM). The Centers for Medicare & Medicaid Services (CMS) estimates less than 40% of eligible clinicians (ECs) are required to submit MIPS data, with only 15 points required to avoid the 5% penalty on the table in 2018.

If you are a small practice – defined as 15 ECs or less – there will be a hardship exemption available from the “Promoting Interoperability” category (the new name for Advancing Care Information). The exception is granted simply for being small, but other categories include a decertified electronic health record (EHR) system or an EHR system switch midway through the year. The application has yet to be released, but will be due on December 31, 2018.

In 2017, 91% of all MIPS-eligible clinicians participated in the first year of the QPP, according to CMS’ announcement last month. “Official” scores will be released sometime in July, although preliminary scores are now available. The high level of participation is welcome by CMS, although it means less money will be distributed as bonuses to participants. With the exception of funds available for “exceptional performers,” this budget-neutral program requires the losers feed the winners. Because there are so few losers this year, don’t expect a financial windfall.

In the report, CMS provides a look into the crystal ball for the future. Administrator Seema Verma announced: “Under the Bipartisan Budget Act of 2018, we have additional authority to continue our gradual implementation of certain requirements for three more years to further reduce burden in areas of MIPS.” This is welcome news for physicians seeking relief from the government’s red tape.


Elizabeth Woodcock, MBA, FACMPE, CPC

About the Author

Elizabeth Woodcock is the founder and principal of Woodcock & Associates. She has focused on medical group operations and revenue cycle management for more than 20 years and has led educational sessions for the Medical Group Management Association, the American Congress of Obstetricians & Gynecologists, and the American Medical Association. She has authored and co-authored many books. She is frequently published and quoted in national publications including The Wall Street Journal, Family Practice Management, MGMA Connexion, and American Medical News. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a Bachelor of Arts from Duke University, she completed a Master of Business Administration in healthcare management from The Wharton School of Business of the University of Pennsylvania.


The contents of The Sentinel are intended for educational/informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and/or change over time.