*In 2026 and subsequent years, the non-APM conversion factor will be set as “equal to the respective conversion factor for the previous year (or, in the case of 2026, equal to the single conversion factor for 2025) multiplied by the update established under paragraph (20) for such respective conversion factor for such year.”
** The Secretary has the authority to create additional MIPS bonuses for “exceptional performers” through 2024.
*** “Partial Qualifying APM Participants” (as defined in the legislation) who report on applicable MIPS measures are considered to be a “MIPS eligible professional” in that year. The Secretary may also base the determination by using “counts of patients in lieu of using payments and using the same or similar percentage criteria . . .as the Secretary determines appropriate.”
**** “Qualifying APM Participant”: 2019-2020: 25% of Medicare payments furnished as part of an eligible APM; 2021-2022: 50% of Medicare payments furnished as part of an eligible APM; or professionals with at least 25% of Medicare payments from services furnished as part of an eligible APM AND at least 50% of all payer payments (excluding VA, DOD, and in certain cases Medicaid) for services provided as part of an eligible APM (provided that the professional is willing to provide data to CMS to be able to make that determination). 2023 and subsequent years: 75% of Medicare payments furnished as part of an eligible APM; or professionals with at least 25% of Medicare payments from services furnished as part of an eligible APM AND at least 75% of all payer payments (excluding VA, DOD, and in certain cases Medicaid) for services provided as part of an APM (provided that the professional is willing to provide data to CMS to be able to make that determination). 2021 and subsequent years: The Secretary may also base the determination by using “counts of patients in lieu of using payments and using the same or similar percentage criteria . . .as the Secretary determines appropriate.”
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