The Quality Payment Program started on January 1, 2017. Prior to the QPP, payment increases for Medicare services were set by the Sustainable Growth Rate (SGR) law. This capped spending increases according to the growth in the Medicare population, and a modest allowance for inflation.
However, as clinicians increased their utilization of services, the reimbursement for each unit of service had to be adjusted downward to hold costs constant. In practice, the SGR would have resulted in large decreases in the Physician Fee Schedule, which was not sustainable. To avoid these decreases in reimbursement, Congress had to pass a new law (every year) authorizing the current fee schedule and a small increase for inflation.
With the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS did away with the SGR. Now, they are able to reward high value, high quality Medicare clinicians with payment increases – while at the same time reducing payments to those clinicians who aren’t meeting performance standards.
Here are important dates for the program.
November 1, 2018
CMS released 2019 Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019
December 31, 2018
Performance Year 2018 ends
Deadline to file PI Hardship Exemption
Fourth Snapshot date for full TIN APMs (Medicare Shared Savings Program) for determining which eligible clinicians are participating in a MIPS APM for purposes for the APM scoring standard
QP determinations are made approximately 4 months after each snapshot date. Check the QPP Participation Tool for updates to your APM status. Learn more in our QP Methodology Fact Sheet.
January 1, 2019
The first payment adjustments based on Performance Year 2017
Performance Year 2019 begins
January 2, 2019, 10am EST
Submission Window Opens for Performance Year 2018
You may submit and update your data any time while the submission window is open.
January 22, 2019
CMS Web Interface Submission Period Begins for Performance Year 2018
Registered groups may submit group data in the CMS Web Interface during the 9 week submission window.
March 2, 2019
MIPS Claims Data Submission deadline
March 22, 2019 8pm EDT
CMS Web Interface Submission Window Ends for Performance Year 2018
Registered groups may submit group data in the CMS Web Interface during the 9 week submission window.
April 2, 2019 8pm EDT
Submission Window Closes for Performance Year 2018
You may submit and update your data any time while the submission window is open.
July 1, 2019
Performance Feedback Available – CMS will provide you with performance feedback based on the data you submitted for Performance Year 2018. You will be able to use this feedback to improve your care and optimize the payments you receive from CMS.
Targeted Review Opens After the Release of Performance Feedback
New MIPS Terms from Final Rule for 2019 Year Participation
- Collection Type is a set of quality measures with comparable specifications and data completeness criteria including, as applicable: electronic clinical quality measures (eCQMs); MIPS clinical quality measures (CQMs) (formerly referred to as “Registry measures”); Qualified Clinical Data Registry (QCDR) measures; Medicare Part B claims measures; CMS Web Interface measures; the CAHPS for MIPS survey measure; and administrative claims measures.
- Submitter Type is the MIPS eligible clinician, group, or third party intermediary acting on behalf of a MIPS eligible clinician or group, as applicable, that submits data on measures and activities.
- Submission Type is the mechanism by which the submitter type submits data to CMS, including, as applicable: direct, log in and upload, log in and attest, Medicare Part B claims, and the CMS Web Interface. There is no submission type for cost data because the data is collected and calculated by CMS from administrative claims data submitted for payment.