Table of Contents
Executive Summary/Background………………………………………………………………………………………….6
Overview…………………………………………………………………………………………………………………………………6
QPP Strategic Objectives…………………………………………………………………………………………………………….6
One QPP………………………………………………………………………………………………………………………………….6
Summary of the Major Provisions…………………………………………………………………………………………………7
QPP Year 2 ………………………………………………………………………………………………………………………………………7
Small Practices…………………………………………………………………………………………………………………………………7
Summary of Major Provisions for Advanced APMs……………………………………………………………………………….7
Summary of Major Provisions for MIPS……………………………………………………………………………………………….8
Payment Adjustments………………………………………………………………………………………………………………10
Benefits and Costs of Proposed Rule……………………………………………………………………………………………11
Provisions of the Proposed Regulations……………………………………………………………………………….11
Definitions……………………………………………………………………………………………………………………………..11
MIPS Program Details ………………………………………………………………………………………………………………11
MIPS Eligible Clinicians ………………………………………………………………………………………………………………….. 11
Definition of a MIPS Eligible Clinician…………………………………………………………………………………………………………..11
Group Practice………………………………………………………………………………………………………………………………………….12
Small Practices………………………………………………………………………………………………………………………………………….12
Rural Area and Health Professional Shortage Area Practices…………………………………………………………………………..13
Non-Patient Facing MIPS Eligible Clinicians…………………………………………………………………………………………………..13
MIPS Eligible Clinicians Who Practice in Critical Access Hospitals Billing under Method II…………………………………..14
MIPS Eligible Clinicians Who Practice in Rural Health Clinics or Federally Qualified Health Centers …………………….14
MIPS Eligible Clinicians Who Practice in Ambulatory Surgical Centers, Home Health Agencies, Hospice, and Hospital
Outpatient Departments……………………………………………………………………………………………………………………………14
MIPS Eligible Clinician Identifier………………………………………………………………………………………………………………….14
Exclusions…………………………………………………………………………………………………………………………………….. 14
New Medicare-Enrolled Eligible Clinician……………………………………………………………………………………………………..14
Qualifying APM Participant (QP) and Partial Qualifying APM Participant (Partial QP) ………………………………………..14
Low-Volume Threshold………………………………………………………………………………………………………………………………14
Group Reporting …………………………………………………………………………………………………………………………… 16
Virtual Groups………………………………………………………………………………………………………………………………. 16
Definition of a Virtual Group ………………………………………………………………………………………………………………………16
MIPS Virtual Group Identifier for Performance……………………………………………………………………………………………..17
Application of MIPS Group Policies to Virtual Groups…………………………………………………………………………………….18
Virtual Group Election Process……………………………………………………………………………………………………………………18
Virtual Group Eligibility Determinations……………………………………………………………………………………………………….19
Virtual Group Agreements …………………………………………………………………………………………………………………………20
Virtual Group Reporting Requirements………………………………………………………………………………………………………..21
Assessment and Scoring of Virtual Groups for the MIPS Performance Categories……………………………………………..21
MIPS Performance Period………………………………………………………………………………………………………………. 22
MIPS Performance Category Measures and Activities……………………………………………………………………….. 22
Submission Mechanisms ……………………………………………………………………………………………………………………………22
Submission Deadlines………………………………………………………………………………………………………………………………..23
Quality Performance Criteria………………………………………………………………………………………………………………………23
Cost Performance Category………………………………………………………………………………………………………………………..29
Improvement Activity Criteria …………………………………………………………………………………………………………………….31
Advancing Care Information (ACI) Performance Category………………………………………………………………………………37
APM Scoring Standard for MIPS Eligible Clinicians in MIPS APMs ……………………………………………………….. 46
Assessment Dates for Inclusion of MIPS Eligible Clinicians in APM Entity Groups Under APM Scoring Standard……47
Calculating MIPS APM Performance Category Scores…………………………………………………………………………………….47
Calculating Total APM Entity Score ……………………………………………………………………………………………………………..52
Additional Provisions Addressed in General MIPS Scoring Standard ………………………………………………………………..52
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