Healthy People, Healthy Communities
Quality Payment Program
HealthInsight Can Help your Practice with QPP
We can help you maximize the well-being of your patients and staff while staying financially viable.
Serving New Mexico, Nevada, Oregon and Utah
HealthInsight is ready to help practices take an integrated approach to the Quality Payment Program. We have studied the rules and stay informed on updates, clarifications and CMS learning opportunities. Some of the support we can offer:
- Strategies to address multiple aspects of QPP while building your practice's capacity to achieve long-term success under alternative payment models
- Guidance on how to use new revenue codes to build your practice's capacity to succeed across many newer payment programs
- Support on how to advance through the stages of QPP to succeed initially and as the requirements build
- Resources to help meet program requirements
- Linkage to HealthInsight initiatives to count toward meeting QPP requirements
- Connecting with your state health information exchange to help support QPP
- Support for measure selection that aligns to your goals and priorities across MIPS categories
Health Care Practitioners in Nevada, New Mexico, Oregon and Utah:
HealthInsight is offering technical assistance and strategies to ensure success in the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program. This support is available at no cost to your practice. We have studied the rules and stay informed on updates, clarifications and learning opportunities from CMS.
New Mexico providers with 15 or fewer eligible clinicians
For New Mexico practices with 15 or fewer health care practitioners, particularly those in medically underserved and rural areas, the Health Services Advisory Group, Inc., (HSAG) headquartered in Phoenix, Arizona, has been selected to provide this support, also at no cost to the practice. HealthInsight intends to work collaboratively with HSAG in developing a smooth hand-off process to seamlessly assist smaller practices on their Quality Payment Program efforts. HealthInsight will continue to assist practices in New Mexico with 16 or more health care practitioners.
Resources
Understanding the Quality Payment Program
QPP: Billing Office Information
Get an overview of the QPP scoring system and evaluation/performance timeframe through 2022, as well as links to informative resources for your billing office.
Get an overview of the QPP scoring system and evaluation/performance timeframe through 2022, as well as links to informative resources for your billing office.
QPP Proposed Rule for the Quality Payment Program Year 3 Fact Sheet
Understand the proposed policies for Year 3 (2019) of the Quality Payment Program via the Medicare Physician Fee Schedule (PFS) Notice of Proposed Rulemaking (NPRM) with this fact sheet released by CMS.
Understand the proposed policies for Year 3 (2019) of the Quality Payment Program via the Medicare Physician Fee Schedule (PFS) Notice of Proposed Rulemaking (NPRM) with this fact sheet released by CMS.
A Quick Start Guide to the Merit-Based Incentive Payment System
This guide is for 2018 participation in the program.
This guide is for 2018 participation in the program.
Quality Payment Program Year 2 Final Rule Overview
View this overview from CMS to review some of the important program changes in the Quality Payment Program Year 2.
View this overview from CMS to review some of the important program changes in the Quality Payment Program Year 2.
QPP Participation Status (MIPS and APM)
On this webpage, clinicians can enter their 10-digit National Provider Identifier (NPI) number to receive their QPP Participation Status, which includes APM Participation as well as MIPS Participation information
On this webpage, clinicians can enter their 10-digit National Provider Identifier (NPI) number to receive their QPP Participation Status, which includes APM Participation as well as MIPS Participation information
Quality Payment Program - Explore Measures Tool
This tool has been created to help you get familiar with the different measures you can submit and prepare for the year. It's for planning purposes only and will not submit anything to CMS, but you can use this tool to explore (search, browse, or filter) available measures, add measures you're interested in to your list, and download your list of interested measures for reference.
This tool has been created to help you get familiar with the different measures you can submit and prepare for the year. It's for planning purposes only and will not submit anything to CMS, but you can use this tool to explore (search, browse, or filter) available measures, add measures you're interested in to your list, and download your list of interested measures for reference.
No Cost Online MIPS Estimator
This comprehensive, accurate, easy-to-use, online tool is available at no cost to support clinicians and health care organizations to succeed in the Merit-based Incentive Payment System (MIPS). The Estimator provides clinicians individualized, instant feedback about their MIPS status and accelerates planning for quality improvement. Access all of the information needed about MIPS in one place to prepare for reporting, self-assess current performance across the MIPS categories, determine how to make workflow changes to improve patient outcomes, and work towards improving your MIPS score to achieve the highest possible reimbursement.
This comprehensive, accurate, easy-to-use, online tool is available at no cost to support clinicians and health care organizations to succeed in the Merit-based Incentive Payment System (MIPS). The Estimator provides clinicians individualized, instant feedback about their MIPS status and accelerates planning for quality improvement. Access all of the information needed about MIPS in one place to prepare for reporting, self-assess current performance across the MIPS categories, determine how to make workflow changes to improve patient outcomes, and work towards improving your MIPS score to achieve the highest possible reimbursement.
Steps to Success for MIPS 2018
A six-step guide to reporting in the Merit-based Incentive Payment System (MIPS)
A six-step guide to reporting in the Merit-based Incentive Payment System (MIPS)
Quality Resources
Quality Fact Sheet
Quality measures are tools that help us measure health care processes, outcomes, and patient experiences of their care. This fact sheet on the MIPS Quality Performance category can help show how CMS is using Quality measures and what you need to submit under that category, as well as other valuable links.
Quality measures are tools that help us measure health care processes, outcomes, and patient experiences of their care. This fact sheet on the MIPS Quality Performance category can help show how CMS is using Quality measures and what you need to submit under that category, as well as other valuable links.
2018 Quality Payment Program (QPP) Measure Specification and Measure Flow Guide for Registry Submission of Individual Measures
This document contains general guidance for the 2018 Quality Payment Program Individual Measure Specifications and Measure Flows for registry submissions, including detailed descriptions of the quality measures and measure flows and associated algorithms to be used as a resource for the application of logic for data completeness and performance.
This document contains general guidance for the 2018 Quality Payment Program Individual Measure Specifications and Measure Flows for registry submissions, including detailed descriptions of the quality measures and measure flows and associated algorithms to be used as a resource for the application of logic for data completeness and performance.
Quality Payment Program - Quality Measures
This performance category measures health care processes, outcomes, and patient care experiences. Use this interactive, online tool to review and select up to six quality measures that meet your needs or specialty. Then download a CSV file of the selected measures for your records.
This performance category measures health care processes, outcomes, and patient care experiences. Use this interactive, online tool to review and select up to six quality measures that meet your needs or specialty. Then download a CSV file of the selected measures for your records.
Cost Resources
Cost Category Information for Providers
In the 2022 performance year, the Cost Category is scheduled to become 30 percent of the MIPS final score. View this informational one-pager to find out more about the Cost Category, how the score is calculated and review helpful hints.
In the 2022 performance year, the Cost Category is scheduled to become 30 percent of the MIPS final score. View this informational one-pager to find out more about the Cost Category, how the score is calculated and review helpful hints.
AMA’s 2018 Medicare QPP FAQs: Cost Category
This document was developed by the American Medical Association (AMA) as a supplement to their MIPS Action Plan and provides additional information about the 2018 MIPS Cost category under the Quality Payment Program (QPP).
This document was developed by the American Medical Association (AMA) as a supplement to their MIPS Action Plan and provides additional information about the 2018 MIPS Cost category under the Quality Payment Program (QPP).
Cost Fact Sheet
View this CMS fact sheet to see what the MIPS Cost Performance Category is and how CMS scores for cost, as well as other valuable links.
View this CMS fact sheet to see what the MIPS Cost Performance Category is and how CMS scores for cost, as well as other valuable links.
Quality Payment Program – Cost Requirements
Cost is an important part of MIPS because it measures resources that clinicians use to care for patients and the Medicare payments for care (items and services) given to a beneficiary during an episode of care. Use this interactive, online tool to review and select cost measures.
Cost is an important part of MIPS because it measures resources that clinicians use to care for patients and the Medicare payments for care (items and services) given to a beneficiary during an episode of care. Use this interactive, online tool to review and select cost measures.
MIPS: Total Per Capita Costs for All Attributed Beneficiaries
The Total Per Capita Costs for All Attributed Beneficiaries (TPCC) measure is a payment-standardized, annualized, risk-adjusted, and specialty-adjusted measure that evaluates the overall cost of care provided to beneficiaries attributed to clinicians, as identified by a unique Taxpayer Identification Number/National Provider Identifier (TIN-NPI). The Total Per Capita Costs for All Attributed Beneficiaries measure can be reported at the TIN or the TIN-NPI level. See this document to learn more.
The Total Per Capita Costs for All Attributed Beneficiaries (TPCC) measure is a payment-standardized, annualized, risk-adjusted, and specialty-adjusted measure that evaluates the overall cost of care provided to beneficiaries attributed to clinicians, as identified by a unique Taxpayer Identification Number/National Provider Identifier (TIN-NPI). The Total Per Capita Costs for All Attributed Beneficiaries measure can be reported at the TIN or the TIN-NPI level. See this document to learn more.
MIPS: Medicare Spending Per Beneficiary
The Medicare Spending Per Beneficiary (MSPB) clinician measure assesses the cost to Medicare of services performed by an individual clinician during an MSPB episode, which comprises the period immediately prior to, during, and following a patient’s hospital stay. See this document to learn more.
The Medicare Spending Per Beneficiary (MSPB) clinician measure assesses the cost to Medicare of services performed by an individual clinician during an MSPB episode, which comprises the period immediately prior to, during, and following a patient’s hospital stay. See this document to learn more.
2016 Quality and Resource Use Reports (QRUR) and 2018 Value Modifier
CMS will make the Annual Quality and Resource Use Reports (QRURs) available for 2016. This page will contain additional links to templates, methodologies and supporting information for the 2016 Annual QRURs and the 2018 Value Modifier.
CMS will make the Annual Quality and Resource Use Reports (QRURs) available for 2016. This page will contain additional links to templates, methodologies and supporting information for the 2016 Annual QRURs and the 2018 Value Modifier.
Promoting Interoperability (formerly ACI) Resources
Quality Payment Program – Promoting Interoperability (formerly Advancing Care Information) Requirements
This performance category promotes patient engagement and electronic exchange of information using certified electronic health record technology (CEHRT). CMS re-named the advancing care information (ACI) performance category to promoting interoperability (PI) to focus on interoperability, improving flexibility, relieving burden. This interactive webpage provides an overview about PI objectives and measures and how to report them. You can also use the online interactive tool to select your measures.
This performance category promotes patient engagement and electronic exchange of information using certified electronic health record technology (CEHRT). CMS re-named the advancing care information (ACI) performance category to promoting interoperability (PI) to focus on interoperability, improving flexibility, relieving burden. This interactive webpage provides an overview about PI objectives and measures and how to report them. You can also use the online interactive tool to select your measures.
Promoting Interoperability Fact Sheet
Get overview information and descriptions about MACRA, MIPS and APMs and a deep-dive description of the Promoting Interoperability performance category under MIPS, as well as other valuable resources.
Get overview information and descriptions about MACRA, MIPS and APMs and a deep-dive description of the Promoting Interoperability performance category under MIPS, as well as other valuable resources.
Promoting Interoperability Measures
Better understand the MIPS Promoting Interoperability (formerly Advancing Care Information) performance measures by reviewing this informative document, which outlines reporting options and requirements.
Better understand the MIPS Promoting Interoperability (formerly Advancing Care Information) performance measures by reviewing this informative document, which outlines reporting options and requirements.
Improvement Activities Resources
List of 2018 MIPS Improvement Activities
Use this link to download a full list of the 2018 Improvement Activities in an Excel sheet and PDF.
Use this link to download a full list of the 2018 Improvement Activities in an Excel sheet and PDF.
CMS IA Fact sheet
View this CMS fact sheet to see what the MIPS Improvement Activities Performance Category is and how to choose and submit Improvement Activities that apply to your practice, as well as other valuable links.
View this CMS fact sheet to see what the MIPS Improvement Activities Performance Category is and how to choose and submit Improvement Activities that apply to your practice, as well as other valuable links.
Quality Payment Program - Improvement Activities Requirements
This performance category gauges participation in activities that improve clinical practice. Get information about the Improvement Activities category under MIPS and then review and select activities that best fit your practice. Then download a CSV file of the selected activities for your records.
This performance category gauges participation in activities that improve clinical practice. Get information about the Improvement Activities category under MIPS and then review and select activities that best fit your practice. Then download a CSV file of the selected activities for your records.
Integrating with the Quality Payment Program: Making Current Improvement Activities Work for You
Get a brief overview about MACRA and the Quality Payment Program and then learn about the Improvement Activities category under MIPS.
Get a brief overview about MACRA and the Quality Payment Program and then learn about the Improvement Activities category under MIPS.
Submission, Feedback, and Payment Resources
MIPS 2017 Performance Feedback User Guide
CMS has posted this document as a resource to help eligible clinicians and groups understand their 2017 Merit-based Incentive Payment System (MIPS) performance feedback. This User Guide discusses who can access MIPS performance feedback, highlights the differences between preliminary performance feedback and final performance feedback, and provides step-by-step instructions for accessing your feedback.
CMS has posted this document as a resource to help eligible clinicians and groups understand their 2017 Merit-based Incentive Payment System (MIPS) performance feedback. This User Guide discusses who can access MIPS performance feedback, highlights the differences between preliminary performance feedback and final performance feedback, and provides step-by-step instructions for accessing your feedback.
2017 Performance Feedback Fact Sheet
This CMS fact sheet provides more information about MIPS Performance Feedback, including an overview of what performance feedback is, who is eligible to receive it and how they can.
This CMS fact sheet provides more information about MIPS Performance Feedback, including an overview of what performance feedback is, who is eligible to receive it and how they can.
MIPS 2019 Payment Adjustment Fact Sheet
This CMS Fact Sheet is available to help eligible clinicians and groups understand their Merit-based Incentive Payment System (MIPS) 2019 payment adjustment, and highlights how CMS assigns final scores to MIPS eligible clinicians, and how payment adjustment factors are applied for 2019 based on 2017 MIPS final scores.
This CMS Fact Sheet is available to help eligible clinicians and groups understand their Merit-based Incentive Payment System (MIPS) 2019 payment adjustment, and highlights how CMS assigns final scores to MIPS eligible clinicians, and how payment adjustment factors are applied for 2019 based on 2017 MIPS final scores.
QPP CMS Portal Reporting Guide
A guide showing how to submit Quality Payment Program data through the CMS portal.
A guide showing how to submit Quality Payment Program data through the CMS portal.
MIPS Enterprise Identity Data Management (EIDM) Account Setup Checklist
A one-page checklist for setting up a EIDM account.
A one-page checklist for setting up a EIDM account.
How to Obtain an EIDM Account and Report for the Quality Payment Program
The CMS Enterprise Identity Management service (EIDM) Account is required for submitting data to the CMS Web Portal in order to report for the Quality Payment Program. This is a step-by-step guide on how to fully create and access your account.
The CMS Enterprise Identity Management service (EIDM) Account is required for submitting data to the CMS Web Portal in order to report for the Quality Payment Program. This is a step-by-step guide on how to fully create and access your account.
Targeted Review of the 2019 MIPS Payment Adjustment Fact Sheet
A targeted review is a process where MIPS eligible clinicians or groups can request that CMS review the calculation of their 2019 MIPS payment adjustment factor and, as applicable, their additional MIPS payment adjustment factor for exceptional performance. Clinicians are encouraged to request a targeted review at the same level (individual or group) as the data was submitted to MIPS. Find out more with this fact sheet.
A targeted review is a process where MIPS eligible clinicians or groups can request that CMS review the calculation of their 2019 MIPS payment adjustment factor and, as applicable, their additional MIPS payment adjustment factor for exceptional performance. Clinicians are encouraged to request a targeted review at the same level (individual or group) as the data was submitted to MIPS. Find out more with this fact sheet.
MIPS EIDM Guide
This guide is for users who need an Enterprise Identity Data Management (EIDM) account and/or ‘Physician Quality and Value Program’ role to submit or access QPP data.
This guide is for users who need an Enterprise Identity Data Management (EIDM) account and/or ‘Physician Quality and Value Program’ role to submit or access QPP data.
Videos
How to Access Performance Feedback for Groups
This video will provide an overview of how to access 2017 MIPS performance feedback for clinicians who participated as a group.
This video will provide an overview of how to access 2017 MIPS performance feedback for clinicians who participated as a group.
How to Access Performance Feedback for Voluntary Submitters (4 min)
Provides an overview of how to access 2017 performance feedback data for a clinician who voluntarily submitted data for 2017.
Provides an overview of how to access 2017 performance feedback data for a clinician who voluntarily submitted data for 2017.
How to Access Performance Feedback for Individuals (9 min)
Demonstrates how to access 2017 MIPS performance feedback for a clinician whose performance was scored separately from his or her group.
Demonstrates how to access 2017 MIPS performance feedback for a clinician whose performance was scored separately from his or her group.
How to Access Performance Feedback for APM Entities (7 min)
Description: Provides an overview of how to access 2017 MIPS performance feedback for Alternative Payment Model (APM) Entities.
Description: Provides an overview of how to access 2017 MIPS performance feedback for Alternative Payment Model (APM) Entities.
How to Request a Targeted Review (7 min)
Demonstrates how MIPS eligible clinicians or groups can request a targeted review of their 2019 MIPS payment adjustment.
Demonstrates how MIPS eligible clinicians or groups can request a targeted review of their 2019 MIPS payment adjustment.
Advanced Alternative Payment Models
QPP Advanced APMs, APMs and MIPS APMs
Curious about Alternative Payment Models (APMs), Advanced APMs, Accountable Care Organizations (ACOs) and MIPS APMs? This overview gives a brief outline of each and guidance for enrollment.
Curious about Alternative Payment Models (APMs), Advanced APMs, Accountable Care Organizations (ACOs) and MIPS APMs? This overview gives a brief outline of each and guidance for enrollment.
APM Table Published
CMS has published a table displaying the Alternative Payment Models (APMs) that CMS operates. In the table CMS identifies which of those APMs CMS has determined to be MIPS APMs or Advanced APMs.
See the table here: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Comprehensive-List-of-APMs.pdf
A Guide to Physician-Focused Alternative Payment Models
American Medical Association and the Center for Healthcare Quality and Payment Reform
American Medical Association and the Center for Healthcare Quality and Payment Reform
Introduction to Advanced Alternative Payment Models
In this lesson, JP Sharp, CMS Innovation Center MACRA Lead, explains Advanced Alternative Payment Models (APMs) under the Quality Payment Program. You will learn about the basics of Alternative Payment Models, Advanced APMs, and the benefits of participating in an Advanced APM.
In this lesson, JP Sharp, CMS Innovation Center MACRA Lead, explains Advanced Alternative Payment Models (APMs) under the Quality Payment Program. You will learn about the basics of Alternative Payment Models, Advanced APMs, and the benefits of participating in an Advanced APM.
Understanding Payment Reform
The Building Blocks of Successful Payment Reform: Designing Payment Systems that Support Higher–Value Health Care
Network for Regional Healthcare Improvement
Network for Regional Healthcare Improvement
Accelerating the Implementation of Value-Based Care and Payment - Recommendations from the 2016 National Payment Reform Summit
Network for Regional Healthcare Improvement
Network for Regional Healthcare Improvement
Webinars
MIPS Tips - Advanced Alternative Payment Models (Advanced APMs): June 7, 2018 - Slides
MIPS Tips - Advanced Alternative Payment Models (Advanced APMs): June 7, 2018 - Slides
MIPS Tips - Advanced Alternative Payment Models (Advanced APMs): June 7, 2018 - Slides
MIPS Tips - Year 2 Deep Dive and Aligned MIPS Strategy: May 10, 2018 - Slides
MIPS Tips - Year 2 Deep Dive and Aligned MIPS Strategy: May 10, 2018 - Slides
MIPS Tips - Year 2 Deep Dive and Aligned MIPS Strategy: May 10, 2018 - Slides
MIPS Tips - MIPS & Cybersecurity: April 12, 2018
MIPS Tips - MIPS & Cybersecurity: April 12, 2018 - Slides
MIPS Tips - MIPS & Cybersecurity: April 12, 2018 - Slides
MIPS Tips - Jan. 11, 2018 Q&A Overview
All of the questions and answers that were discussed during the Jan. 11, 2018 MIPS Tips session.
All of the questions and answers that were discussed during the Jan. 11, 2018 MIPS Tips session.
QPP Webinar Series - 2 minute Warning - Sept. 19, 2017 -Recording
Join this information session to understand what it means to participate in MIPS with a test, partial and full reporting submission, and the benefits to participating to the greatest extent possible this year. Leave the session with a clear plan for gathering and reporting your performance data in each MIPS category. The first part of this session will include a review of all the steps you need to take to report for 2017. The second half will be an open question and answer session with MIPS experts.
QPP Webinar Series - 2 minute warning - Sept. 19, 2017 - Slide Deck
QPP Webinar Series - 2 minute warning - Slide Deck Webinar presented on Sept. 19, 2017
QPP Webinar Series - 2 minute warning - Slide Deck Webinar presented on Sept. 19, 2017
QPP Webinar Series - Improving Your Score with eCQI - July 11, 2017 Recording
This session will include information on using the eCQI process to select areas for improvement and how to use a methodology to guide the improvement process.
QPP Webinar Series - Improving Your Score with eCQI - July 11, 2017 Slides
QPP Webinar Series - Improving Your Score with eCQI - July 11, 2017 Slides
QPP Webinar Series - Improving Your Score with eCQI - July 11, 2017 Slides
QPP Webinar Series - Submission and Scoring Methods - June 27, 2017 Recording
This will be an in-depth session on how to score each category.
This will be an in-depth session on how to score each category.
QPP Webinar Series - Submission and Scoring Methods - June 27, 2017 Slides
QPP Webinar Series - Submission and Scoring Methods - June 27, 2017 Slides
QPP Webinar Series - Submission and Scoring Methods - June 27, 2017 Slides
QPP Webinar Series- MIPS Deep Dive: Advancing Care Information and Costs - May 23, 2017 - Recording
This session will include a deeper dive into two components of the MIPS portion of QPP, including costs and advancing care information. Tools you can use today to assess your costs will be reviewed, along with ways to improve interoperability.
QPP Webinar Series- MIPS Deep Dive: Advancing Care Information and Costs - May 23, 2017 - Slides
Slides from the QPP Webinar Series- MIPS Deep Dive: Advancing Care Information and Costs - presentation on May 23, 2017
Slides from the QPP Webinar Series- MIPS Deep Dive: Advancing Care Information and Costs - presentation on May 23, 2017
QPP Webinar Series - MIPS Deep Dive: Quality and Improvement Activities - May 16, 2017 - Recording
This session will include a deeper dive into the MIPS portion of QPP, including information on how you can be successful in the MIPS program, how to choose quality measures, how to improve quality measures, documentation and reporting, and how to complete an improvement activity.
QPP Webinar Series- MIPS Deep Dive- Quality and Improvement Activities - May 16, 2017 - Slides
Copy of the slide deck for the QPP webinar presented on May 16, 2017
Copy of the slide deck for the QPP webinar presented on May 16, 2017
QPP Webinar Series - QPP Overview May 9, 2017- Recording
This session will include a broad overview of the QPP program including who it impacts, what it is, when it will start, how it fits into the big picture and how to be successful in the QPP program.
This session will include a broad overview of the QPP program including who it impacts, what it is, when it will start, how it fits into the big picture and how to be successful in the QPP program.
QPP Webinar Series - QPP Overview May 9, 2017 - Slides
QPP Webinar Series- Slides from the overview of the Quality Payment Program webinar presented on May 9, 2017.
QPP Webinar Series- Slides from the overview of the Quality Payment Program webinar presented on May 9, 2017.
Specialty Resources
Our specialty packets contain applicable measures for the Quality, Promoting Interoperability and Improvement Activities categories along with helpful scoring information. Use these as a starting point for your 2018 MIPS action plan or to review your current plan to confirm you are on the right track.
Contact Us
Email us or call the number below to get in contact for any questions you may have.
Email: qpp@healthinsight.org
Phone: 801-892-6623