Quality Payment Programs (QPP)

What You Should Know

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:

Bill $90,000 or less in Medicare Part B allowed charges for covered professional services payable under the Physician Fee Schedule; or
Provider covered professional services for 200 or fewer Part B-enrolled individuals; or
Provide 200 or fewer covered professional services to Part B-enrolled individuals.

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.

Traditional Merit-based Incentive Payment System (MIPS): Eligible Clinicians (ECs) and groups participating in the Merit-based Incentive Payment System (MIPS) will earn up to 100 points based upon their performances in four performance categories (Quality, Cost, Promoting Interoperability, and Improvement Activities). Non-participation in MIPS when an individual or group is required to participate will result in those ECs and groups receiving a -9% payment adjustment on their Medicare Part B payments.
MIPS Value Pathways (MVPs): The MVP policy was established in the 2023 reporting year to ease the burden placed on individuals and groups participating in MIPS. According to CMS, the MVP framework “aims to align and connect measures and activities across the quality, cost, and improvement activities performance categories of MIPS for different specialties or conditions.”
Alternative Payment Program (APP): The APP is an optional MIPS reporting and scoring pathway for MIPS eligible clinicians identified on the Participation List or Affiliated Practitioner List of any APM Entity participating in any MIPS APM. Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) would be required to report through the APP for purposes of assessing their quality performance for that program, but MIPS eligible clinicians participating in these ACOs also would have the option of reporting outside the APP, or within it at an individual or group level, for purposes of being scored under MIPS, like all other MIPS APM participants.
Alternative Payment Models: Advanced Alternative Payment Models (APMs) reward eligible clinicians and practices for taking on some risk related to their patients’ outcomes. An APM often applies to three primary categories, specific clinical condition, a care episode, or patient population.

Current MIPS Performance Year Information:

In Performance Year 2026, 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 2028. Those practices scoring exactly 75 points will receive a neutral adjustment. Those scoring above 75 points will receive a positive payment adjustment. Performance category weights are Quality 30%, Cost 30%, Promoting Interoperability 25%, and Improvement Activities 15%.

What is ASA Doing for You

ASA advocates in front of CMS on quality measures, quality measure development and maintenance.
We submit comments on behalf of ASA members and AQI NACOR registry participants in response to the Quality Payment Program federal rules and regulations.
We support individual and group MIPS reporting via the Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry (AQI NACOR).