Quality Payment

Quality care

Avoid penalties and earn bonuses for high quality patient care

If you treat Medicare Part B patients, you'll likely need to take part in the Quality Payment Program (QPP) to avoid penalties.

The Centers for Medicare and Medicaid Services (CMS) Quality Payment Program aims to improve health outcomes for Medicare patients by providing physician payment increases as a reward for high value, high quality care, while reducing payments for physicians who do not meet performance standards.

If you are a DO who provides medical services to patients that you bill for under the Medicare Physician Fee Schedule, you are likely subject to requirements of the Quality Payment Program. You can use your NPI number to learn whether you’re required to participate.

The QPP consists of two tracks:

Merit-Based Incentive Payment System (MIPS), which requires physicians to report various types of practice data
Advanced Alternative Payment Models (APMs), an alternative care model in which practices shoulder more risk related to patient outcomes

Read on to learn how each track works and how the AOA can help your practice participate successfully.

MIPS Guide

MIPS, the first track of the Quality Payment Program, awards you a 5% penalty or bonus in 2020 based on the MIPS data you submit for the 2018 practice year. Find out how to check whether you’re required to participate in MIPS, how to succeed in the program, and how our exclusive tools for AOA members can make reporting easier.

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APM Guide

The second track of the Quality Payment Program, joining an advanced alternative payment model (APM), rewards practices for taking on two-sided financial risk. If you’re participating in an APM in 2018, you’ll need to get at least 25% of Medicare Part B payments through the advanced APM or treat at least 20% of your patients through the advanced APM.

Questions? We can help.

AOA members can get free, personalized help navigating the Quality Payment Program by contacting the AOA. If you’re not already a member, learn how to join the AOA.

Small, rural & underserved practices

If you’re in a practice with 15 or fewer physicians or you practice in a rural or underserved area, you can contact the Center for Medicare & Medicaid Services for extra support with the Quality Payment Program.

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Who’s exempt from the Quality Payment Program?

Physicians who are in their first year participating in Medicare; bill less than $30,000 in Medicare Part B charges yearly; or treat fewer than 100 Medicare patients per year are exempt from the Quality Payment Program. To learn whether you need to participate in MIPS, check the CMS MIPS Lookup Tool.

Applying for hardship exceptions

MIPS-eligible physicians who fall into these categories can apply for a hardship exemption from the Quality Payment Program:

Spotty internet connectivity.
Your practice doesn’t have certified electronic health record technology for reasons outside your control.
Extreme and uncontrollable circumstances, such as a natural disaster in your area, bankruptcy, or the closure of your practice.