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CMS releases 2018 Quality Payment Program Final Rule

Last month, CMS released its final rule on the 2018 Quality Payment Program established under MACRA (Medicare Access and CHIP Reauthorization Act of 2015). This final rule describes changes to policies for the second transition year for the Merit-Based incentives Payment System (MIPS) and for Advanced Alternative Payment Models (APMs). CMS did finalize several important policy changes, including several to help physician in small practices. The impact analysis projects that 97 percent of eligible clinicians will avoid a penalty in 2020 based on their QPP participation in 2018. Other highlights include:

  • Significantly expands the low-volume threshold to $90,000 of less in Medicare Part B allowed charges OR 200 of fewer Medicare Part B patients. This is a change from the initial threshold of $30,000 in allowed charges or 100 patients;

  • Creates virtual groups to assist small practices;

  • Adds 5 bonus points to the final MIPS scores for practices of 15 or fewer clinicians;

  • Adds up to 5 bonus points to the final MIPS score for clinicians that treat complex patients;

  • Cost has been weaved back in to the program after its absence in the 2017 performance year. For 2018, cost will have a 10 percent weight and could rise to 30 percent in 2019.

For more information, check out the CMS fact sheet. If you have questions or concerns regarding the final rule please contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance.

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