The Quality Payment Program provides two general pathways for physicians to receive negative, neutral, or positive adjustments to their Medicare Part B covered professional services payments. These pathways are the Merit-based Incentive Payment System (MIPS) (including Traditional MIPS, MIPS Value Pathways (MVPs) and the Alternative Payment Program (APP)), and Advanced Alternative Payment Models (APMs). It is important to understand your reporting options and how they apply to your practice.
Eligibility: Individuals and groups that do not meet the low volume threshold are not required to report MIPS or participate in an APM. Physicians, their groups, and other clinicians that fall under the low-volume threshold are exempt from MIPS participation if they:
Individuals and groups that exceed at least one but not all of the thresholds may opt-in to report MIPS. Once an individual or group decides to submit data to CMS via the opt-in option, they will be scored and receive payment adjustments based upon their performance will apply. Check your eligibility on the Centers for Medicare & Medicaid Services (CMS) website.
Anesthesiologists and their groups may report MIPS and MVPs through the Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry (AQI NACOR).
Current MIPS Performance Year Information:
In Performance Year 2023, the performance threshold to receive a positive payment adjustment is 75 points. Individuals and groups scoring below 75 points will receive a negative payment adjustment in 2025. Those practices scoring exactly 75 points will receive a neutral adjustment. Those scoring above 75 points will receive a positive payment adjustment. The exceptional performance bonus is no longer available. Performance category weights are Quality 30%, Cost 30%, Promoting Interoperability 25%, and Improvement Activities 15%.
Please send your questions on the QPP to the ASA Department of Quality and Regulatory Affairs (QRA) at email@example.com.
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This page is curated by the ASA Department of Quality and Regulatory Affairs and was last updated December 2022.