News & Insights

New Year, New QPP Rules

December 06, 2017

New Year, New QPP Rules

On November 2, 2017, the Quality Payment Program (QPP) Year 2 Final Rule was published. CMS considers the 2018 performance year to be another transition year allowing providers additional time to get ready for full implementation in 2019. The following are a few of the key changes that will become effective January 1, 2018:

  • Non-participation penalty increases to 5%
  • Low Volume Threshold is increasing to $90,000 and 200 Medicare Part B patients
  • Quality will count for 50%, Improvement Activities (IA) 15%, Advancing Care Information (ACI) 25% and Cost will count for 10% of the total MIPS score
  • Quality and Cost will be evaluated on a full year reporting period. ACI and IA will remain at 90 days.
  • 2014 and 2015 Certified EHR Technology will be acceptable. A 10% bonus will be given to eligible clinicians who utilize 2015 CEHRT.
  • The minimum score to avoid a penalty will increase from 3 to 15 points
  • Providers demonstrating an improvement in their quality measure scoring between 2017 and 2018 on quality measures can earn up to a 10% bonus
  • More exceptions, exemptions and bonuses will be available
  • Individual and small groups can form virtual groups. The deadline for establishing a virtual group for 2018 reporting is December 31, 2018.
    • A virtual group is a combination of solo practitioners and/or small group practices (with no more than 10 eligible clinicians), who elect to form a group for reporting purposes for a given performance year in the QPP.  

LAMMICO will provide more details regarding the 2018 performance period in the coming months, but we can still help you to avoid a 4% penalty in 2019!

Did you receive a CMS letter stating you were going to be penalized in 2018?

Fortunately, that penalty will only last for one year. However, you must report some data in 2017 to avoid a penalty in 2019! Report one measure, on one patient, during one visit before December 31, 2017 to avoid an automatic 4% decrease in Part B reimbursements in 2019! Many of the Quality Measures are services routinely performed in most medical offices and can be reported for free using a standard CMS 1500 claim form, requiring minimal provider and staff time.

Contact LAMMICO Practice Management Specialist, Natalie Cohen, MBA, MHA, by email or at 504.841.2727 for more information or assistance.

This is not legal advice, and is not intended to substitute for individualized business of financial judgment. It does not dictate exclusive methods, and is not applicable to all circumstances.


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