Quality programs & regulatory support
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Quality program and support guides
Get the essentials from this overview of the 2021 Quality Payment Program, including: changes to the scoring system and level of positive or negative adjustment to your Medicare reimbursements, exemptions and reporting methods for small practices, plus bonus points and support for small practices.
Do you have a MIPS action plan? Our checklist walks you through how to avoid a penalty and potentially earn the full positive adjustment.
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Frequently asked questions
What is MACRA?
MACRA is the Medicare Access and CHIP Reauthorization Act, which is legislation that replaced the Sustainable Growth Rate (SGR). It outlines a new program for physician reimbursement that replaces fee-for-service with value-based payments under the Quality Payment Program (QPP).
What is the Quality Payment Program?
The QPP is the portion of MACRA that defines the new value-based reimbursement system. It has two parts: the Merit-Based Incentive Program (MIPS) and Advanced Alternative Payment Models (APMs). The QPP replaces and consolidates the current Medicare Meaningful Use, PQRS, and value-based modifier programs.
Who participates in the QPP?
The following provider types must participate in the QPP in either MIPS or APMs: physician (doctor of medicine or osteopathy, dental surgery or dental medicine, podiatric medicine, or optometry; chiropractor), physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, physical therapist, occupational therapist, clinical psychologist, qualified speech-language pathologist, qualified audiologist, and registered dietitian or nutritional professional.
Do I need a certified EHR to participate in the Quality Payment Program?
Yes, for both MIPS and the APMs, you need a certified EHR. Starting in 2018, the EHR must be 2015 Edition certified.
Are there exceptions to the eligible provider?
Yes, there are two exceptions applications available to clinicians in the 2021 performance year: the Extreme and Uncontrollable Circumstances Exception and the MIPS Promoting Interoperability Performance Category Hardship Exception.
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Is your independent practice or billing company prepared for 2022 adjustments in patient collections?Watch webinar
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Contrary to popular belief, participating in regulatory programs is simple. With automated MIPS tracking workflows, healthcare providers can earn up to a well-deserved 9% positive payment adjustment.Watch webinar