CY 2018 Updates to the Quality Payment
Program (QPP) and QPP Extreme and
Uncontrollable Circumstance Policy for the
Transition Year
A SIDE-BY-SIDE COMPARSION OF KEY PROVISIONS FROM THE PROPOSED AND FINAL RULES
IMPLEMENTING YEAR TWO OF THE QPP.
Table of Contents
Overview…………………………………………………………………………………………………………………………………………………………………………………….3
MIPS Program Details……………………………………………………………………………………………………………………………………………………………………4
MIPS Eligible Clinicians……………………………………………………………………………………………………………………………………………………………………………….4
Exclusions………………………………………………………………………………………………………………………………………………………………………………………………..7
Group Reporting ……………………………………………………………………………………………………………………………………………………………………………………….8
Virtual Groups ………………………………………………………………………………………………………………………………………………………………………………………….9
MIPS Performance Period …………………………………………………………………………………………………………………………………………………………………………16
MIPS Performance Category Measures and Activities …………………………………………………………………………………………………………………………………….17
APM Scoring Standard for MIPS Eligible Clinicians in MIPS APMs………………………………………………………………………………………………………………………41
MIPS Final Score Methodology …………………………………………………………………………………………………………………………………………………………………..47
MIPS Payment Adjustments………………………………………………………………………………………………………………………………………………………………………71
Review and Correction of MIPS Final Score …………………………………………………………………………………………………………………………………………………..73
Third Party Data Submission………………………………………………………………………………………………………………………………………………………………………76
Public Reporting on Physician Compare……………………………………………………………………………………………………………………………………………………….82
Overview of the APM Incentive …………………………………………………………………………………………………………………………………………………….90
Definitions and Regulatory Text Changes……………………………………………………………………………………………………………………………………………………..90
Qualifying APM Participant (QP) and Partial QP Determination………………………………………………………………………………………………………………………..92
All-Payer Combination Option……………………………………………………………………………………………………………………………………………………………………94
Physician-Focused Payment Models (PFPMs)………………………………………………………………………………………………………………………………………………104
Extreme and Uncontrollable Circumstance Policy for the Transition Year Interim Final Rule with Comment Period……………………………………. 107
Collection of Information Requirements ………………………………………………………………………………………………………………………………………. 109
Regulatory Impact Analysis………………………………………………………………………………………………………………………………………………………… 110
Change in Medicare Payments …………………………………………………………………………………………………………………………………………………………………110
Regulatory Review Costs…………………………………………………………………………………………………………………………………………………………………………112
APPENDIX A: 2018 ACI Objectives and Measures with Proposed Modifications and Exclusions………………………………………………………………. 113
APPENDIX B: 2018 ACI Transition Objectives and Measures with Finalized Modifications and Exclusions…………………………………………………. 120
APPENDIX C: Other Payer APM Determinations: Payer Initiated Process ……………………………………………………………………………………………. 125
APPENDIX D: Other Payer APM Determinations: Eligible Clinician Initiated Process……………………………………………………………………………… 128
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