On December 1, 2020, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule CY 2021 final rule and associated fact sheet, which also includes provisions of the Quality Payment Program. The rule includes final policies for the implementation of the revised office/outpatient evaluation and management services, discussion on the complex patient care services code G2211, and the implementation of policies affecting the provision of telehealth services. In addition, CMS explains policies associated with the COVID-19 pandemic including new coding and payment for virtual check-in services and personal protective equipment (PPE). While issued as a final rule, the Agency is accepting comments for the coding and payment policies for virtual check-ins and for PPE. Stay tuned for more information.
CMS Announces Relief for Clinicians Participating in the Quality Payment Program in 2020
In response to the COVID-19 public health emergency, CMS has announced flexibilities for clinicians participating in the Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) in 2020.
Clinicians significantly impacted by the public health emergency may submit an Extreme & Uncontrollable Circumstances Application to reweight any or all of the MIPS performance categories. If you are requesting relief via the application, you will need to provide a justification of how their practice has been significantly impacted by the public health emergency.
Please review the 2020 Exception Applications Fact Sheet for more information, helpful hints, and FAQs about submitting an Extreme & Uncontrollable Circumstances Application.
If you have questions, please contact the QPP at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, please consider calling during non-peak hours—before 10:00 a.m. and after 2:00 p.m. ET.
Quality Payment Program (as Required by MACRA)
The Centers for Medicare & Medicaid Services (CMS) began the Quality Payment Program (QPP) on January 1, 2017. The QPP fulfills the mandate of the Medicare Access and CHIP Reauthorization Act (MACRA) to implement an incentive program that rewards Medicare-participating clinicians for high quality, cost efficient, value-based care. The QPP comprises two tracks: the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). ID physicians may choose which track to participate in based on practice size, location, or patient population.
Most ID physicians will participate in the MIPS. For information on your MIPS eligibility, enter your 10-digit National Provider Identifier (NPI) into the CMS QPP Participation Status tool.
CMS updates the Quality Payment Program and physician payment formulas annually, typically through issuing first a proposed rule, on which it receives public comment, and then a final rule. IDSA continually submits comment letters to CMS on the proposed and final QPP/ Physician fee schedule rules advcoating on behalf of our members.
The American Medical Association (AMA) offers podcasts, learning modules, and webinars to help physicians and their staff prepare for participation in the QPP.