The Two QPP Reporting Options
MIPS and APMs
MIPS
Merit-based Incentive Payment System
MIPS combines parts of various old value-based care system into one new program, in which Eligible Clinicians are measured on four specific performance categories:
- Quality (replaced PQRS)
- Improvement Activities (new category)
- Promoting Interoperability (replaced Meaningful Use)
- Cost (replaced Value-Based Payment Modifier)
For 2020 and 2021, clinicians who bill $90,000 or more in Medicare Part B allowed charges, see more than 200 Part B-enrolled Medicare beneficiaries, and provide 200 or more covered professional services to Part B Medicare patients are eligible for MIPS. Such eligible providers must participate or face reimbursement penalties.
APMs
Alternative Payment Models
Alternative Payment Models essentially allow for more extensive participation in the transition to Value-Based Care. As of 2019, advanced APM participation requires providers to either a) receive 50 percent of their Medicare Part B payments through an Advanced APM, OR b) see 35 percent of their Medicare patients through an Advanced APM.
Participation is strictly voluntary and reserved to providers (both MIPS-eligible and not) who meet certain requirements. Such participating clinicians are eligible to receive larger reimbursement incentives, while potentially taking on greater financial risk as well.
APM options are designed by the CMS, with the goal of strengthening specific aspects or fields of medical care. Participating physicians contribute valuable data, which helps the CMS shape evaluation standards. APMs apply to a specific clinical condition, a care episode, or a population.
