The Centers for Medicare & Medicaid Services (CMS) has released the 2020 CMS Quality Reporting Document Architecture (QRDA) III Implementation Guide (IG) along with the Schematron and Sample Files.

Seema Verma, Administrator, Centers for Medicare and Medicaid Services recently released an announcement about the Quality Payment Program based on 2018 participation. Please read her message below.

Today, the Centers for Medicare & Medicaid Services (CMS) released its proposed policies for the 2020 performance year of the Quality Payment Program via the Medicare Physician Fee Schedule (PFS) Notice of Proposed Rulemaking (NPRM).

The Centers for Medicare & Medicaid Services (CMS) has contracted with Guidehouse to conduct data validation and audits of a select number of MIPS eligible clinicians. Data validation and audits are processes that will help ensure MIPS is operating with accurate and useful data. MIPS eligible clinicians, groups and virtual groups are required by regulation to comply with data sharing requests, providing all data as requested by CMS.

If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), are now available for review on the Quality Payment Program website.

If you submitted 2018 Merit-based Incentive Payment System (MIPS) data, you can now view your performance feedback and MIPS final score on the Quality Payment Program website.

The Centers for Medicare & Medicaid Services (CMS) has contracted with Guidehouse to conduct data validation and audits of a select number of Merit-based Incentive Payment System (MIPS) eligible clinicians. Data validation and audits are processes that will help ensure MIPS is operating with accurate and useful data. MIPS eligible clinicians, groups and virtual groups are required by regulation to comply with data sharing requests, providing all data as requested by CMS.

The Centers for Medicare & Medicaid Services (CMS) reminds you to submit Promoting Interoperability measures and Improvement Activities for consideration for future years of the Merit-based Incentive Payment System (MIPS). The MIPS Annual Call for Measures and Activities process allows clinicians, professional associations and medical societies that represent clinicians, researchers, consumer groups and others to identify and submit measures and activities.

The Centers for Medicare & Medicaid Services (CMS) has posted the electronic clinical quality measure (eCQM) specifications for the 2020 reporting period for Eligible Hospitals and Critical Access Hospitals, and the 2020 performance period for Eligible Professionals and Eligible Clinicians.

The Centers for Medicare & Medicaid Services (CMS) is collecting information and documentation to determine whether payment arrangements qualify as Other Payer Advanced Alternative Payment Models (APMs) under the Quality Payment Program (QPP).

The Centers for Medicare & Medicaid Services (CMS) recently posted a new Merit-based Incentive Payment System (MIPS) resource to the QPP Resource Library to answer questions and provide additional information on 2019 group participation in MIPS.

The Centers for Medicare & Medicaid (CMS) is studying the Factors Associated with Reporting Quality Measures in 2019, as outlined in the Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2019 final rule (CMS-1693-F).

Groups and Virtual Groups Must Register by July 1, 2019 to Use the CMS Web Interface and/or Administer the CAHPS for MIPS Survey

The data submission period for the 2018 Merit-based Incentive Payment System (MIPS) closed on April 2, 2019. The Centers for Medicare and Medicaid Services (CMS) is currently in the process of reviewing all the data submitted. CMS thanks all of the clinicians who submitted their data, as well as the qualified clinical data registries, qualified registries, EHR vendors, and other organizations that submitted 2018 MIPS data on behalf of clinicians.

The Centers for Medicare & Medicaid (CMS) is studying the Factors Associated with Reporting Quality Measures in 2019, as outlined in the Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2019 final rule (CMS-1693-F).

The data submission deadline for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in Year 2 (2018) of the Quality Payment Program is one week away. Data can be submitted and updated any time until 8:00 p.m. ET on Tuesday, April 2, 2019.

On February 19, 2019, CMS launched CMS: Beyond the Policy, a new podcast series highlighting updates and changes to policies and programs in an easily accessible and conversational format.

The Centers for Medicare & Medicaid Services (CMS) updated the QPP Participation Status tool so clinicians can check to see if they are required to participate in the Quality Payment Program (QPP) in 2019.

CMS has a posted a series of videos to the QPP Resource Library to help clinicians understand how to manage and submit their 2018 Merit-based Incentive Payment System (MIPS) data through the QPP website between now and April 2, 2019.

On December 19, 2018, the Centers for Medicare and Medicaid Services (CMS) transitioned the system to create identity management accounts and request access to the Quality Payment Program (QPP) website from the Enterprise Identity Management (EIDM) System to the HCQIS Access Roles and Profile (HARP) System.

The Medicare Shared Savings Program (Shared Savings Program) and Quality Payment Program (QPP) Interactions Guide for Shared Savings Program performance years during 2019 is now available in the Quality Payment Program Resource Library.

An updated version of the Great Plains QIN-QIO MIPS Calculator for clinicians who are not in an Advanced APM or are not going to report via the Centers for Medicare & Medicaid Services (CMS) Web Interface is now available.

MIPS Eligible Clinicians Can Start Submitting Data for 2018 through April 2

The Centers for Medicare & Medicaid Services (CMS) has officially opened the data submission period for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in Year 2 (2018) of the Quality Payment Program. With the exceptions noted in the paragraph below, data can be submitted and updated any time from January 2, 2019 to April 2, 2019.
 

The Electronic Clinical Quality Measure (eCQM) Strategy Project is an ongoing effort of the Centers for Medicare & Medicaid Services (CMS) and is part of our ongoing commitment to promote efficiency through health information technology while decreasing burden to providers. CMS has now expanded the Electronic Clinical Quality Improvement (eCQI) Resource Center (RC) to include a Collaborative Measure Development (CMD) Workspace. The CMD Workspace brings together a set of interconnected resources, tools, and processes to promote clarity, transparency, and better interaction across stakeholder communities that develop, implement, and report eCQMs.

If you belong to an Accountable Care Organization (ACO), it is recommended that you contact your ACO as soon as possible to ensure you know who is responsible for reporting each of the MIPS categories to CMS. 

The final performance period for the Value Modifier and Physician Quality Reporting System (PQRS) programs was 2016 and the final payment adjustment year is 2018. Therefore, the Quality and Resource Use Reports (QRURs) and PQRS Feedback Reports will no longer be available after December 31, 2018.

The answer to when 2015 Edition Certified Electronic Health Records (EHRs) are required is a complex answer. We will refer to "2015 Edition" and "2015 CEHRT or certified" to help clarify. Although it is recommended that everyone upgrade to 2015 Edition as soon as possible, the upgrade does not have to be complete/certified by January 1, 2019.

One of Quality Insights' peer Quality Payment Program (QPP) technical assistance contractors, Healthinsight, has extended an invitation to complete a 2018 HIPAA Security Risk Analysis to practices in all states in the country.  Now is the time to take action because the 2018 SRA must be completed prior to December 31. Healthinsight can provide assistance at a significantly discounted rate from typical consultants in the industry.

If you participated in the Physician Quality Reporting System (PQRS) and Value Modifier programs, you can view and download your Quality and Resource Use Reports (QRURs) and PQRS Feedback Reports now through December 31; however, they will not be available beginning January 1, 2019.  

The Centers for Medicare & Medicaid Services (CMS) has published a list of payment arrangements with CMS Multi-Payer Models that are Other Payer Advanced APMs for CY 2019 based on submissions from payers made earlier this year through the Payer Initiated Process and based on the Other Payer Advanced APM criteria in effect. Download it here. 
 

The Centers for Medicare & Medicaid Services (CMS) recently updated its QPP Participation Status Tool based on calculations from the second snapshot of Medicare Part B claims data to calculate the Alternative Payment Model (APM) entities threshold scores. The second snapshot are for dates of participation between January 1 and June 30, 2018. To learn more about how CMS determines QP and MIPS APM status for each snapshot, please view the QP Methodology Fact Sheet. As a reminder, the tool includes 2018 Qualifying APM Participant (QP) and MIPS APM status

On November 8, 2018, the Centers for Medicare & Medicaid Services (CMS) released 2017 performance results for the Quality Payment Program. Data elements show significant success and participation in both the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) tracks. Seema Verma, CMS Administrator, announced that program year one exceeded the year one participation goal of 90%.

The Centers for Medicare & Medicaid Services (CMS) has moved Quality Payment Program (QPP) resources from CMS.gov to the newly redesigned QPP Resource Library on qpp.cms.gov. 
 

On Thursday, November 1, 2018, the Centers for Medicare and Medicaid Services (CMS) issued its policies for Year 3 (2019) of the Quality Payment Program via the Medicare Physician Fee Schedule (PFS) Final Rule. The provisions in the rule build on the foundation established in the first two years of the program, and are reflective of the feedback we received from many stakeholders.

The Centers for Medicare & Medicaid Services (CMS) has updated the QPP website so individual eligible clinicians who choose to submit their Quality performance category data via claims can access performance feedback for the 2018 performance year on an ongoing basis.
 

On August 9, 2018, CMS issued a proposed rule that would set a new direction for the Medicare Shared Savings Program (MSSP). Referred to as "Pathways to Success," this proposed new direction for the Shared Savings Program would redesign the participation options available under the program to encourage Accountable Care Organizations (ACOs) to transition to two-sided models (in which they may share in savings and are accountable for repaying shared losses), increase savings for the Trust Funds and mitigate losses, reduce gaming opportunity and increase program integrity, and promote regulatory flexibility and free-market principles

The Centers for Medicare & Medicaid Services (CMS) and its contractor, Acumen, LLC, will conduct field testing for 13 cost measures before consideration of their potential use in the cost performance category of MIPS. From October 3 to 31, 2018, field test reports with information on your cost performance for these measures will be available for you to review and provide feedback.

The final performance period for the Value Modifier and Physician Quality Reporting System (PQRS) programs was 2016 and the final payment adjustment year is 2018. Therefore, the Quality and Resource Use Reports (QRURs) and PQRS Feedback Reports will no longer be available after the end of 2018. All QRURs and PQRS Feedback Reports provided under these programs will remain available for download until December 31, 2018.

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, and you believe an error exists in your 2019 MIPS payment adjustment calculation, you can request a targeted review through October 15 at 8:00 PM EDT. 

Did you know that clinicians or practices that report to a public health or clinical data registry earn 10 points in the Promoting Interoperability category? If they report to a second registry, they can earn an additional five bonus points.

The Centers for Medicare & Medicaid Services (CMS) created a Clinical Champions Program of thought leaders who are enthusiastic about leading change and driving transformation. Those selected will provide perspective on the value of the QPP, identify successes, challenges, and mis-conceptions among their peers, and offer insights to reduce administrative burden.
 

The cost category is worth 10% of the total MIPS score in 2018 and is based on two cost measures:  Medicare Spending Per Beneficiary (MSPB) and Total Per Capita Cost (TPCC).  These measures are based on a full calendar year of Medicare Part A and Part B claims and payments, so clinicians and practices do not need to submit any data for this MIPS performance category.

On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the Physician Fee Schedule Proposed Rule. CMS is seeking your comments, which are due by 5:00 p.m. ET on September 10.

Eligible clinicians and groups that participate in MIPS are required to use certified EHR technology (CEHRT) if they want to report measures in the Promoting Interoperability category.

Today, the Centers for Medicare & Medicaid Services (CMS) updated its Quality Payment Program Participation Status Tool to include 2018 Qualifying APM Participant (QP) and MIPS APM status. The tool has been updated based on calculations from the first snapshot of data from APM entities. The first snapshot includes data from Medicare Part B claims with dates of service between January 1 and March 31, 2018.

The 2018 Quality Payment Program Exception Applications for the Promoting Interoperability (PI) performance category and for Extreme and Uncontrollable Circumstances for the Merit-based Incentive System (MIPS) are now available on the Quality Payment Program website.

The Centers for Medicare & Medicaid Services (CMS) has released several new demo videos on how to access 2017 MIPS Performance Feedback, as well as a video on how to request a Targeted Review, 

The Centers for Medicare & Medicaid Services (CMS) and the National Library of Medicine (NLM) will publish updates to the electronic clinical quality measure (eCQM) value sets to align with the most recent releases to terminologies, including, but not limited to, International Classification of Diseases (ICD)-10 Clinical Modification (CM) and Procedure Coding System (PCS), SNOMED CT, LOINC, RxNorm, and Current Procedural Terminology (CPT).

A frequently asked question by ACO members is “Is it true that I do not need do anything for the Quality Payment Program because I am in an ACO?”

Now that 2017 Final MIPS scores are available, clinicians and groups will have the opportunity to request a “targeted review”.

The Centers for Medicare & Medicaid Services (CMS) updated its Quality Payment Program Look-Up Tool to allow clinicians to view 2018 Merit-based Incentive Payment System (MIPS) eligibility and Alternative Payment Model (APM) Qualifying APM Participant (QP) data—in one place.

If you submitted 2017 Merit-based Incentive Payment System (MIPS) data through the Quality Payment Program website, you can now view your performance feedback and MIPS final score.

CMS is not sending written letters in the mail to notify clinicians of their 2018 MIPS eligibility status. Therefore, everyone is responsible for checking their 2018 MIPS eligibility status by going to the QPP website. 

Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys ask consumers about their experiences with health care. The CAHPS program at the U.S. Agency for Healthcare Research and Quality (AHRQ) supports the development and promotion of CAHPS surveys, instructional materials, and comparative databases, and provides technical assistance to users. Learn more about AHRQ's CAHPS program.

Hopefully you submitted 2017 MIPS data and have viewed your Preliminary Feedback Report. If not, you should go to the Quality Payment Program (QPP) website and log in to the QPP portal using your valid Enterprise Identity Data Management (EIDM) account to check your 2017 preliminary Merit-based Incentive Payment System (MIPS) score.

Today, CMS Administrator Seema Verma issued a blog announcing successes in reporting 2017 Quality Payment Program Year 1 Submission Results.
 

Everyone that is 2018 MIPS eligible must have an EIDM account because EIDM login credentials are utilized to login to the Quality Payment Program (QPP) portal. The QPP portal also houses preliminary and final MIPS feedback reports.

Year two of the MIPS program introduces new opportunities for solo practitioners and small group practices. Although you may know what MIPS requires in 2018, learning how to successfully meet these requirements while continuing to effectively serve your community and meet your financial goals is essential. 
 

Eligible clinicians can now log in to the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program website to check your group's 2018 eligibility for the Merit-based Incentive Payment System (MIPS).

 In 2017, the MIPS maximum payment adjustment was +/- four percent. The number of MIPS eligible clinicians (ECs) who did not report will determine how much the positive payment adjustment is for those that did report and have a MIPS score greater than three.

In 2018, the MIPS maximum payment adjustment increased to +/- five percent.
 

The Centers for Medicare & Medicaid Services (CMS) is conducting the 2018 Burdens Associated with Reporting Quality Measures Study, as outlined in the Quality Payment Program Year 2 final rule (CMS 5522- FC).

The Centers for Medicare & Medicaid Services (CMS) hasy launched the Patients Over Paperwork initiative with the goal of reducing the regulatory burden imposed by CMS on our nation's healthcare professionals.

Groups Must Register to Use the CMS Web Interface and/or CAHPS for MIPS Survey by June 30, 2018

Registration is required for groups that intend to use the CMS Web Interface and/or administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for Merit-based Incentive Payment System (MIPS) survey for 2018. To register, please visit the Quality Payment Program website. The registration period is from April 1, 2018 through June 30, 2018.

If you’re an eligible clinician participating in the Quality Payment Program, you now have until Tuesday, April 3, 2018 at 8 PM EDT to submit your 2017 MIPS performance data. You can submit your 2017 performance data using the new feature on the Quality Payment Program website.

The Centers for Medicare & Medicaid Services (CMS) recently participated in the 2018 Healthcare Information and Management Systems Society (HIMSS) Annual Conference & Exhibition in Las Vegas from March 5-9, 2018

CMS recently published the Electronic Clinical Quality Measures (eCQM) Annual Update Pre-Publication Document, which describes changes in the standards and code set versions used in the updated measures for potential use in CMS quality reporting programs for 2019 reporting/performance. 

The Meaningful Measures initiative helps CMS find the highest quality measurement and improvement priorities that are most important to improve patient outcomes.

The Bipartisan Budget Act of 2018 enacted by Congress and President Trump on February 9, 2018 extends the transition years for MIPS to include 2019, 2020 and 2021.

Deadlines are fast approaching if you plan to submit data for the 2017 MIPS performance period. For group reporting via the CMS web interface, the deadline is March 16 at 8:00 p.m. ET, and for all other MIPS reporting via qpp.cms.gov, the deadline is March 31. Do you have questions about the MIPS data submission process or are you unsure about which measures you should submit data for in each MIPS performance category?

Advancing Care Information Improvement Activities Bonus for 2017 CMS QRDA III

The Centers for Medicare & Medicaid Services (CMS) has identified an additional advancing care information identifier for use with the 2017 CMS Quality Reporting Document Architecture Category III (QRDA III) Implementation Guide (IG) Version 1.0 for Eligible Clinicians and Eligible Professionals Programs.

MIPS Eligible Clinicians Can Now View Performance Scores for 2017 Claims Data on qpp.cms.gov

If you’re an eligible clinician who submitted 2017 Quality performance data for MIPS via claims, you’ll now be able to view your performance scores through the MIPS data submission feature. Reminder: claims data submission is only an option if you’re participating in MIPS as an individual (not as part of a group).

Join Quality Insights for the February edition of QPPLive! to get all your questions answered about the Merit-based Incentive Program (MIPS) and the Quality Payment Program (QPP).

The Centers for Medicare & Medicaid Services (CMS) will be hosting two 90-minute Physician Compare webinars to talk about the recent Physician Quality Reporting System (PQRS) and non-PQRS PY 2016 measures release on Physician Compare.

On December 19, 2017, the Centers for Medicare & Medicaid Services (CMS) published an updated 2017 quality measure benchmark table for MIPS quality measures.

The Centers for Medicare & medicaid Services (CMS) has recently posted several new 2018 Patient-Facing Encounters resources on the CMS website.

The Centers for Medicare & Medicaid Services (CMS) recently released three new instructional videos to help walk eligible clinicians through the MIPS data submission process.

The Centers for Medicare & Medicaid Services (CMS) is accepting recommendations from stakeholders for potential consideration of new specialty measure sets and/or revisions to existing specialty measure sets for program year 2019 of the Merit-based Incentive Payment System (MIPS) program.

CMS Launches New Data Submission System on QPP.CMS.GOV for Clinicians in the Quality Payment Program

On Tuesday, January 2, 2018, the Centers for Medicare & Medicaid Services (CMS) launched a new data submission system for clinicians participating in the Quality Payment Program. Clinicians can now submit all of their 2017 Merit-based Incentive Payment System (MIPS) data through one platform on the qpp.cms.gov website.

The Centers for Medicare & Medicaid Services (CMS) is offering online, self-paced courses about the Quality Payment Program through the MLN Learning Management System. There are now seven courses available. 

The Centers for Medicare & Medicaid Services (CMS) has posted several new Merit-based Incentive Payment System (MIPS) resources on CMS.gov.

The Centers for Medicare & Medicaid Services (CMS) announced that it is now offering two new accredited online courses.

On November 2nd, the Centers for Medicare & Medicaid Services (CMS) issued the final rule with comment for the second year of the Quality Payment Program (calendar year 2018), as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as well as an interim final rule with comment.

Visit CMS.gov to View New and Existing Quality Payment Program Resources

Time is of the essence! There are now less than 90 days left in 2017. If you are a Merit-based Incentive Payment System (MIPS) eligible clinician this year, do you know what you are going to do to avoid the negative four percent payment adjustment?

This October, Quality Insights, as a partner in the advancement of health information technology to help improve healthcare —is a Proud Partner in National Health IT Week.

The Quality Payment Program Hardship Exception Application for 2017 is now available on the Quality Payment Program website. 

A fourth course has been added to the curriculum for the Quality Payment Program (QPP) where learners gain knowledge and insight about the QPP while earning valuable continuing education credit.

On July 24, the Centers for Medicare & Medicaid Services (CMS) distributed an email update with an explanation for its special status calculation for the Quality Payment Program. The message incorrectly stated that clinicians considered to have "special status" would be exempt from the Quality Payment Program.

All Doctors of Medicine or Osteopathy (MD or DO), Doctors of Dental Surgery or Dental Medicine (DDS or DMD), Doctors of Podiatric Medicine (DPM), Doctors of Optometry (OD) and Chiropractors who have never successfully attested to Meaningful Use prior to 2017 must submit a one-time hardship exception application prior to October 1, 2017 to avoid the 2018 payment adjustment if the clinician is transitioning to MIPS and intends to report Advancing Care Information measures in 2017. 
 

The Centers for Medicare and Medicaid Services (CMS) has introduced new information on its Quality Payment Program (QPP) website that indicates whether clinicians have "special status" and can therefore be considered exempt from the QPP.
 

A new, online and self-paced overview course on the Quality Payment is now available through the MLN Learning Management System. Learners will receive information on:

• The Improvement Activities performance category requirements, and how this category fits into the larger Quality Payment Program
• The steps you need to take to report Improvement Activities data to CMS
• The basics about scoring of the Improvement Activities performance category

Proposed rule aims to simplify reporting requirements and offer support for doctors and clinicians in 2018.

If you are unsure about whether you and/or the clinicians in your practice need to submit data to the Merit-based Incentive Payment System (MIPS), use the newly released NPI Look-up Tool to find out.
 

On April 26, 2017 CMS posted a resource for the Improvement Activity category that lists each improvement activity, tells you how the activity will be validated, and lists the documentation that is required.