June 21, 2018

CMS Offers Useful Physician QPP Eligibility Tool

Physicians can now access the Quality Payment Program (QPP) Look-Up Tool from the Centers for Medicare & Medicaid Services (CMS) to learn if they are eligible to report information under the Merit-Based Incentive Payment System (MIPS) or are considered a qualifying physician (QP) under an Advanced Alternative Payment Model (APM).

The QPP Look-Up Tool can help physicians make the following important determinations.

If a physician receives a QP status, they are eligible for a 5 percent bonus in 2020 based on their 2018 Part B Medicare billings. This requires the APM to take on risk, use certified electronic health records and have defined measures that physicians are helping to report to Medicare.

If the APM does not meet all of these requirements, the physician will be considered a MIPS/APM where Medicare will use the APMs reported measures and possibly improvement activities to determine a score and thus a bonus or penalty (+5 percent to -5 percent) for the physician for 2018 payable in 2020.

If a physician is MIPS eligible, they then know that they are expected to report measures, attest to improvement activities and to promoting interoperability (use of EHRs), and possibly will be held accountable for costs. CMS will determine a score and thus a bonus or penalty (+5 percent to -5 percent) for the physician for 2018 payable in 2020.

CMS checks its data quarterly to determine if more physicians qualify under one of these categories as the year progresses. Likewise, physicians should check the look up tool multiple times per year to make sure they are aware of their most current CMS status.

Visit the ACR MACRA Resources webpage for further details on the 2018 MIPS reporting requirements and qualifying 2018 APMs.