month, CMS delivered its final rule on the Quality Payment Program, starting
January 1st, 2018. The following are eight critical points from the Final Rule
that you should be aware of:
- The low-volume threshold for MIPS was
increased- The 2018
final rule raises the low-volume limit so that fewer providers will be subject
to MIPS. The adjustment makes providers that bill less than $90,000 in Medicare
Part B charges or treat fewer than 200 Medicare Part B beneficiaries, exempt
- MIPS category weight shift- The final rule reweights the quality
and cost performance categories. Below is the updated performance category
weighting for 2018:
- Quality 50%
- Cost 10%
- Improvement Activities 15%
- Advancing Care Information
- More bonus opportunities- Physicians in practices of 15 providers
or less can now earn five additional points by submitting data on at least one
performance category. Providers can also earn up to five bonus points for
treating complex patients. (as defined by the Hierarchical Condition Categories
(HCCs) and the number of dually eligible patients treated)
- Electronic Health Records- According to the new rule, CMS will
permit the use of 2014 Edition EHRs and provide a bonus for 2015 Edition
- Hardship exception- CMS added a hardship exception for
providers and practices affected by hurricanes Harvey, Irma, and Maria. The
2018 rule also includes a provision for extreme and uncontrollable
- New clinical improvement activities- CMS is changing the previously adopted clinical
improvement activities, and finalizing new activities for 2018.
- Creation of virtual groups- CMS
is now allowing solo practitioners and small practices the choice to form or
join a Virtual Group to participate with other practices. Individual physicians
and groups of 10 or fewer eligible providers will now be able to band together
regardless their location or specialty, to report on MIPS measures.
- Easier participation in Advanced APMs- The new rule is making it easier for
eligible clinicians to participate in Advanced APMs, which may allow them to
qualify for incentive payments. Specific policies include:
an extension to the 8% revenue based nominal amount standard to qualify for
Advanced APM, through performance year 2020.
Round 1 Comprehensive Primary Care Plus participants currently participating
clinicians from the 50-clinician limit on organizations that can earn incentive payments
by participating in medical home models.
the requirement for Medical Home Models so that the minimum required amount of
total financial risk increases more slowly.
it easier for clinicians to qualify for incentive payments by participating in
Advanced APMs that begin or end in the middle of a year.
from the final rule can be found at: