Quality Payment Program

What’s the Quality Payment Program?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate (SGR) formula and by law, required us to implement the Quality Payment Program. If you participate in Medicare Part B, you’re part of the dedicated team of clinicians who serve more than 55 million of the country’s most vulnerable Americans. The Quality Payment Program will give you new tools and resources to help you give your patients the best possible care. You have 2 ways to choose how you want to participate based on your practice size, specialty, location, or patient population:

• Advanced Alternative Payment models (APMs) or
• The Merit-based Incentive Payment System (MIPS)

If you choose to be part of an Advanced APM, through Medicare Part B you might earn an incentive payment for participating in an innovative payment model.

If you choose to participate in MIPS, you’ll earn a performance-based payment adjustment.

You can find information about the Quality Payment Program here and at QPP.CMS.gov.

Quick help links

• Use the MIPS lookup tool or Qualifying APM Participant (QP) lookup tool to see if you need to participate in the Quality Payment Program.

What's new

Quality Payment Program final policies (Within the Physician Fee Schedule final rule)

Learn what the Year 3 policies mean for you:

• Year 3 final rule overview fact sheet
• Year 3 final rule executive summary
• Final policies for Year 3 of the Quality Payment Program (Federal Register)
• A quick start guide to the Merit-Based Incentive Payment System (MIPS) for 2019 participation

Here are the resources in the Final Rule for MIPS Cost Performance category section:

• Measure methodology documents: The measure methodology for each of the 8 episode-based cost measures. These are the measures finalized for the MIPS cost performance category in the CY2019 PFS final rule.
• Measure codes list files: The list of codes that specify each of the 8 episode-based cost measures. These are the measures finalized for the MIPS cost performance category in the CY2019 PFS final rule.

View the Physician Fee Schedule NPRM press release and fact sheet.

For your reference

• Get fact sheets from the QPP resource library.
• Attend or replay webinars.
• Watch our training videos.
• Learn more about the Physician Focused Payment Models (PFPMs) Technical Committee.
• Read and comment on the patient relationship categories and codes.
• Find the Episode Groups summary and make comments on the Supplemental Episode Groups, Episode Workbooks, and Design Report.
• Request a CMS speaker to give your group more details about the Quality Payment Program. 
• Find the Quality Payment Program widgets.