Quality Payment Program

CMS Quality Payment Program

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The Centers for Medicare & Medicaid Services (CMS) has changed the way it pays many types of providers, including physicians and other clinicians. The Quality Payment Program improves Medicare by helping providers focus on quality care and the one thing that matters most, making patients healthier.

What’s the Quality Payment Program?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate (SGR) formula, which would have significantly cut payment rates for participating Medicare clinicians. MACRA requires the implementation of an incentive program, the Quality Payment Program. There are 2 ways clinicians can choose to participate in the Quality Payment Program:

  1. The Merit-based Incentive Payment System (MIPS): If you’re a MIPS eligible clinician, you’ll be subject to a performance-based payment adjustment through MIPS.
  2. Advanced Alternative Payment Models (APMs): 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.