Let Our QPP Consultants help you successfully transform your practice to these new Cost and Quality Initiatives in the Quality Payment Program (QPP).

The Quality Payment Program/ MACRA

The Quality Payment Program/ MACRA

The Quality Payment Program as part of The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a bipartisan federal legislation. MACRA repeals the Sustainable Growth Rate (SGR) Formula that has determined Medicare Part B reimbursement rates for physicians and replaces it with new ways of paying for care.

Under the Quality Payment Program, participating providers will be paid based on the quality and effectiveness of the care they provide. A large percentage of the physician payment will be based on value  and outcomes of their care (not on volume). High value care commonly referred to as value-based care will be defined by measures of quality and efficiency and providers will be incentivized or decremented based on their performance against those measures.

CMS believes that the Quality Payment Program improves Medicare by helping you focus on care quality and the one thing that matters most — making patients healthier.

The Quality Payment Program has two tracks you can choose from:

Advanced Alternative Payment Models (APMs)

If you decide to take part in an Advanced APM, you may earn a Medicare incentive payment for participating in an innovative payment model.


The Merit-based Incentive Payment System (MIPS)

If you decide to participate in traditional Medicare, you may earn a performance-based payment adjustment through MIPS.





What you do in 2020 will impact what you get paid in 2022.

 For 2020 reporting period, a MIPS eligible provider or practice has billed for more than $90,000 and has provided care for more than 200 patients.

Advanced APM

  • Comprehensive ESRD Care Model (Large Dialysis Organization arrangement)
  • Comprehensive Primary Care Plus (CPC+)
  • Medicare Shared Savings Program – (Track 2 & 3)
  • Next Generation ACO
  • Oncology Care Model Two-Sided Risk Arrangement


  • Physicians
  • PAs
  • NPs
  • Clinical nurse specialists
  • CRNs
  • Anesthetists
  • Groups that include such clinicians

Quality Payment Program Participants

You are eligible to participate in the MIPS track of the Quality Payment Program if you bill more than $90,000 to Medicare, and provide care to more than 200 Medicare patients per year, and you are one of the following:


Physician Assistant

Nurse Practitioner

Clinical Nurse Specialist

Certified Registered Nurse Anesthetist

If 2018 is your first year participating in Medicare, then you are not required to participate in the Quality Payment Program in 2018.

Contact Us Today to Learn How We Can Successfully Assist You in Participating in the Quality Payment Program (QPP)