Physicians Unqualified for Advanced APMs Placed Into MIPS

Physicians not meeting the qualification standards for the advanced APM track of MACRA's Quality Payment Program will be forced into participating in MIPS.

This article was originally published on September 7, 2017, on the Association of Clinical Documentation Improvement Specialists.

What happens to physicians who did not meet the qualification thresholds for the advanced Alternative Payment Models (APM) track of MACRA’s Quality Payment Program by August 31? They’ll be placed into the Merit-based Incentive Payment System (MIPS) for the 2017 performance year and the corresponding 2019 payment year.

To qualify as an advanced APM, according to Modern Healthcare, a group’s participants must use certified EHR technology, pay for covered professional services using quality measures similar to those under MIPS, and the group must be either a medical home model or take on significant risk.

Participants in the program have to receive a certain percentage of their Part B payments or see a certain percentage of patients through an advanced APM. In exchange for this participation, CMS will administer 5% bonus payments in 2019 to successful advanced APM participants, according to Modern Healthcare.

Those who fail to qualify for an advanced APM have to hustle in order to qualify for payments under MIPS, which is running under a new model this year. In this new model, participants are penalized for not submitting anything and rewarded for submitting data, though CMS specified that participants aren’t technically required to submit anything. There will be increasing rewards based on the portion of data reported. 

Editor’s note: To read more about the new quality program updates for the 2017 reporting year, click here. To read about CMS’ resources regarding quality payment programs, click here.