View this CMS Guide to understand more about the basics of the MIPS program, including resources to help you get started.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that a unique identifier be assigned to each health care provider and health plan. Accordingly, CMS uses enrollment systems, including the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) and the National Plan & Provider Enumeration System (NPPES), to manage provider information and identifiers. Learn more about this and how it applies to your participation in the Quality Payment Program with this resource.
This one-pager from Comagine Health and Mountain-Pacific Quality Health outlines what a Direct email is and how to use it at a high level.
This CMS document addresses the extreme and uncontrollable circumstances exception application as it applies to MIPS-eligible clinicians affected by natural disasters or a public health emergency (e.g., COVID-19 pandemic), as well as the MIPS Promoting Interoperability (PI) hardship exception application for the 2020 performance period.
This CMS resource contains instructions for updating web browsers so that users can access the Quality Payment Program Website at qpp.cms.gov during the fall 2020 federal network security update.
This checklist is a tool for eligible clinicians and staff to prepare for and submit data for the 2020 MIPS program.
During the COVID-19 emergency, it is important for everyone to practice social distancing and stay at home. The Medicare population, especially those with comorbid conditions, are most at risk. Telehealth provides an opportunity for patients to stay home and receive healthcare for non-emergency medical conditions. This document aids understanding this important tool.
2020 MIPS Participation is as easy as 1-2-3 with this informational pamphlet from Comagine Health. Find out the first steps when getting started with MIPS. Successfully submitting data to the Merit Based Incentive Payments System (MIPS) in 2020 will help you avoid up to a -9% penalty, and or earn up to +9% adjustment on professional fees submitted on your Part B Medicare claims in 2022.
A CMS guide to help clinicians get started participating in MIPS during the 2020 performance period.
For 2020 reporting, which determines your 2022 payment, CMS has set the performance threshold at 45 points. View this informative document from Comagine Health to help understand how eligible clinicians can meet the performance threshold and avoid a payment penalty.
This CMS fact sheet provides a high-level overview of the Quality Payment Program (QPP) final policies for the 2020 performance year.
See this flyer from Comagine Health for an easy overview of the benefits of reporting MIPS.
There were many important changes to MIPS performance categories since the beginning of the program — which we are here to help you navigate. See this flyer created by Comagine Health for a brief overview of the 2020 changes for qualified participants.
On this CMS webpage, clinicians can enter their 10-digit National Provider Identifier (NPI) number to receive their QPP Participation Status, which includes APM Participation as well as MIPS Participation information.
This CMS guide details how to participate in the Quality performance category of MIPS in 2020.
This Excel worksheet will assist with Quality Data Codes for reporting Quality Measures for MIPS using claims in 2020, and features the QDC codes for the 55 claims measures located in each measure specification in the 2020 Medicare Part B Claims Measure Specifications and Supporting Documents.
The Quality category requirement for MIPS is to report six measures. Finding applicable measures for your practice may be challenging. Review this Q & A resource for answers about these very helpful Single Source documents when choosing measures to report.
The Medicare Annual Wellness Visit (AWV), including Personalized Prevention Plan Services (PPPS), is an excellent way to perform needed services and capture MIPS Quality measure data at the same time. Review this resource to find out more about how AWVs can assist in capturing valuable Quality data.
Clinicians in small practices (= 15 clinicians) that submit at least one Quality measure will earn bonus points in MIPS, and only small practices can submit quality measures via Medicare Part B claims in 2020. Use this guide to navigate reporting Quality measures using Medicare Part B claims.
This CMS resource provides a list of Quality measures that currently include telehealth for the 2020 performance period.
This CMS fact sheet summarizes policy updates finalized in the CY 2020 PFS Final Rule, available here, as it pertains to QCDRs and Qualified Registries for the 2020 and 2021 performance period of MIPS.
Provides a list of the 2020 QCDRs for the MIPS from CMS.
This Zip file from CMS provides comprehensive descriptions of the 2020 clinical quality measures for the MIPS Quality performance category. This includes the Single Source file spreadsheets, which are tools that eligible clinicians can use to search for common CPT codes, measure numbers, etc. within each individual registry measure. This may assist in identifying measures that may apply to your practice based on common codes that you may utilize when seeing beneficiaries.
Learn more about Quality benchmarks and how they can affect your MIPS score with this CMS fact sheet. This resource provides an overview of how we establish MIPS Quality measure benchmarks, how benchmarks are used for scoring, and the information in the 2020 Quality Benchmarks and 2020 Multi-Performance Rate Measures files.
The CMS Quality Payment Program website allows clinicians to search a comprehensive list of Quality measures by year, and includes links to the Medicare Part B Claims Measure Specifications, the CMS Web Interface Measure Specifications, the Quality Benchmarks and all supporting documents.
This resource from Comagine Health allows you to easily see the Quality measures that have been removed and added in the 2020 Performance Year for MIPS.
A guide from CMS to help clinicians in small practices get started with using Medicare Part B claims to report participation in the Quality performance category of MIPS during the 2020 performance period.
A CMS guide to help clinicians get started participating in the Quality performance category of MIPS during the 2020 performance period.
Provides a list of the 2020 Qualified Registries for the MIPS from CMS.
A detailed list of the 2020 MIPS Quality Measures from CMS.
This performance category measures health care processes, outcomes and patient care experiences. Use this interactive CMS website to review and select up to six Quality measures that meet your needs or specialty. Then download a CSV file of the selected measures for your records.
Ensuring patients know where to go to receive the appropriate level of care can help MIPS-eligible providers and clinics improve their Cost performance category scores. This one-page guide from Mountain-Pacific Quality Health Foundation will help your patients know where to go when they need care.
This CMS guide details how to participate in the Cost performance category of MIPS in 2020.
Understanding Hierarchical Condition Categories (HCC) and their applicability to the MIPS is important as clinicians work to receive recognition for the care they deliver to patients with complex conditions. Review this Q & A to get answers about HCC and how it could impact your Cost score in MIPS.
The CMS Quality Payment Program website allows clinicians to search a comprehensive list of measures by year, including information from the Cost forms and codes.
A comprehensive CMS guide to help clinicians get started participating in the Cost performance category of MIPS during the 2020 performance period.
This document from CMS provides a summary of Cost measures in relation to MIPS.
Episode-based measures are being used to evaluate cost — beginning with eight added in the 2019 MIPS performance period, and 10 more added in 2020. Episode-based measures differ from the TPCC and MSPB measures because episode-based measure specifications only include items and services that are related to the episode of care for a clinical condition or procedure as opposed to including all services that are provided to a patient over a given time. This CMS Zip file has the PDFs of each Measure Information Form for all 18 measures, along with the 2020 TPCC and MSPB-C PDFs (also found separately in the Cost resources).
Cost is an important part of MIPS because it measures resources that clinicians use to care for patients and the Medicare payments for care (items and services) given to a beneficiary during an episode of care. Use this interactive CMS website to review and select Cost measures.
The Total Per Capita Costs for All Attributed Beneficiaries (TPCC) measure is a payment-standardized, annualized, risk-adjusted, and specialty-adjusted measure that evaluates the overall cost of care provided to beneficiaries attributed to clinicians, as identified by a unique Taxpayer Identification Number/National Provider Identifier (TIN-NPI). The Total Per Capita Costs for All Attributed Beneficiaries measure can be reported at the TIN or the TIN-NPI level. See this document to learn more.
The Medicare Spending Per Beneficiary (MSPB) clinician measure assesses the cost to Medicare of services performed by an individual clinician during an MSPB episode, which comprises the period immediately prior to, during, and following a patient’s hospital stay. See this document to learn more.
A CMS guide to help clinicians get started participating in the Promoting Interoperability performance category of the MIPS during the 2020 performance year.
The Security Risk Analysis (SRA) is a requirement for the Promoting Interoperability (PI) category of MIPS as well as the HIPAA Security Rule. Review this resource to find out more about SRAs that can help your practice achieve better PI scoring.
This Zip file contains a detailed overview of the requirements for the 2020 Promoting Interoperability performance category objectives and measures straight from CMS.
A comprehensive CMS guide to help clinicians get started participating in the Promoting Interoperability performance category of MIPS during the 2020 performance period.
The CMS Quality Payment Program website allows clinicians to search a comprehensive list of the Promoting Interoperability measures by year, including their documentation requirements.
Patient engagement can have big benefits for your practice and your patients: Better communication, better care, and better outcomes. Health information technology (health IT) is a powerful tool to help you get there — so learn how to make it work for you, using the Patient Engagement Playbook as your guide. The Playbook is an evolving resource from the Office of the National Coordinator for Health Information Technology for clinicians, practice staff, hospital staff, and other innovators: A compilation of tips and best practices.
This performance category promotes patient engagement and electronic exchange of information using certified electronic health record technology (CEHRT). CMS re-named the Advancing Care Information (ACI) performance category to Promoting Interoperability (PI) to focus on interoperability, improving flexibility, relieving burden. This interactive webpage provides an overview about PI objectives and measures and how to report them. You can also use the online interactive tool to select your measures.
View this page of resources specifically for those providers needing help with EHR adoption from Comagine Health and others.
View the new CMS Improvement Activity, added for COVID-19, to the 2020 Performance Year inventory.
This CMS resource provides a quick view of the activities that were deleted from the 2020 Improvement Activities inventory.
The CMS Quality Payment Program website allows clinicians to search a comprehensive list of the Improvement Activities by year.
This CMS guide helps clinicians get started participating in the Improvement Activities performance category of MIPS during the 2020 performance period.
CMS Zip file listing the 2020 criteria used to audit and validate data submitted for the MIPS Improvement Activities performance category.
Zip file with the full list of CMS 2020 Improvement Activities in both PDF and Excel format.
This performance category gauges participation in activities that improve clinical practice. This interactive webpage from CMS provides an overview about the Improvement Activities category under MIPS, allows you to review and select activities that best fit your practice, and download a CSV file of the selected activities for your records.
Guide providing details about how scores are calculated for MIPS in the 2020 performance year.
MIPS has provided the same data submission mechanisms since it began in 2017. The guidance regarding reporting with more than one submission method has changed. MIPS also uses new terminology to describe these changes. Review this Q & A for important information to assist with your MIPS submission methods.
Under MIPS, CMS will conduct an annual data validation process. Clinicians are randomly selected for audit, and while it is unknown how many clinicians will receive a request, historical programs audited approximately one in 10 clinicians. This resource will guide you through what information you should retain in case of an audit.
This CMS fact sheet provides a general overview of the 2020 payment adjustments based on MIPS final scores for the 2018 performance year.
The CMS HCQIS Access Roles and Profile (HARP) replaced the Enterprise Identity Management service (EIDM) in 2018. A HARP account is required for submitting data to the CMS Web Portal in order to report for the Quality Payment Program. Use this informative and simple flyer to understand the steps needed to complete your HARP account setup.
The HCQIS Access Roles and Profile (HARP) is a secure identity management portal provided by CMS. View this webpage to get answers to frequently asked questions and other help for the new HARP system.
CMS guide providing an overview of the process to assess performance at the facility level for select MIPS-eligible clinicians, groups and virtual groups whose primary health care responsibilities take place in hospital settings.
CMS’ Hospital Value-Based Purchasing (VBP) Program rewards acute care hospitals with incentive payments for the quality of care they give to people with Medicare. Visit this CMS webpage to find out more about this program and view helpful resources and links.
This short video from CMS provides an overview on how to successfully report MIPS data to the Promoting Interoperability performance category and meet the reporting requirements. It also explains how to modify the Promoting Interoperability score by manually attesting to measures.
This short video from CMS explains how to report MIPS data as an opt-in eligible clinician for the 2019 performance period of the Quality Payment Program. Please note that the opt-in decision is permanent and cannot be changed in the future.
This short video from CMS provides an overview of how to submit MIPS data through the QPP website for the 2019 performance period.
This short video from CMS provides an overview on how a Qualified Registry can report MIPS data and make an election for an opt-in eligible participant through the Registry Dashboard on the Quality Payment Program website. Please note that the opt-in decision is permanent.
This short video from CMS provides an overview of how a third-party intermediary, such as a Qualified Registry, can report MIPS data on behalf of a group within the Quality Payment Program portal, as well as how to modify the Improvement Activity score by manually attesting to measures.
This short video from CMS explains how to upload and review MIPS Quality performance category data in the Quality Payment Program portal and provides an overview of how Quality data is scored during the 2019 MIPS data submission period.
This video from CMS provides an overview of the MIPS Value Pathways (MVPs) participation framework that was finalized in the 2020 Quality Payment Program final rule and will begin in the 2021 performance year.
This video from CMS provides step-by-step instructions on how to add the new clinician role for the QPP. The new role allows clinicians to view their MIPS eligibility details, performance feedback and payments adjustment without having to request access.
Shows how a security official can approve and deny requests from staff users.
Reviews how to request access ("connect") to a Registry or QCDR so you can submit data on behalf of your customers.
Reviews how to request access ("connect") to an Alternative Payment Model (APM) Entity so you can view, submit and manage data on behalf of the APM.
Reviews how to request access (“connect”) to a practice so you can view, submit and manage data on behalf of the practice.
Reviews how to register for and create a new HARP account.
Identify and Evaluate APMs for Your Region
Utilize the information in this section to identify the type of APMs/Accountable Organizations (AOs) in your area, including those that are advanced APMs. The landscape changes rapidly and the two lookup tools below are state-based tools to identify and evaluate Medicare ACOs.
Often systems, clinics, or providers are not aware of what APMs they are involved with. Learn how to identify and compare APMs in your specific region/area by looking this information up with this helpful walkthrough from Comagine Health.
Find out what Medicare ACOs are in your state and what their performance is on key measures. This data is from Medicare Public Use Files and is updated annually. For more information on ACO options, see our other resources, the QPP Advanced Alternative Payment Models overview and the Identify and Compare APMs (Advanced Payment Models – including ACOs) in a Region or Area walkthrough below.
Broader version – looking at multiple ACOs with 2018 data.
Focused version – taking a closer look at one ACO. Same 2018 data.
Once you've identified the Accountable Organizations (AOs) in your area, further review will help determine compatibility of the AO with your goals. The toolkit below has some critical definitions, a checklist to evaluate AOs you are interested in and a checklist to evaluate your own readiness.
The Medicare Annual Wellness Visit (AWV) is designed to encourage and support individuals in taking an active role in accurately assessing and managing their health and improving their well-being and quality of life. The AWV was created by the Centers for Medicare & Medicaid Services (CMS) in 2011 and is a free benefit for Medicare patients. This page is designed to help practices and providers find the tools and resources they need to successfully implement or improve their AWV process.
Learn more about how a clinic achieved success with Medicare Annual Wellness Visits (AWVs).
Implementing CMS' chronic and principal care management (CCM/PCM) services provides an opportunity to put a framework around care coordination, chronic disease management and care management for high-risk patients. Additionally, CCM/PCM services lead to enhanced reimbursement, including for team-based care and work that the care team is already performing. This short, straightforward guidance can help with implementing and capturing reimbursement for the CMS CCM and PCM services.
Are you confused about Alternative Payment Models (APMs), Advanced APMs, MIPS APMs and Accountable Organizations (AOs) such as Accountable Care Organizations (ACOs), Convener Participants (CPs) and Direct Contracting Entities (DCEs)? This toolkit from Comagine Health combines definitions and checklists to help you determine your compatibility with eligible AOs in your region. There are also readiness checklists for Primary Care and Specialists, along with other important resources to consider. Each page can be printed separately so that you can decide what tools you need.
Use this informative sheet from Mountain-Pacific Quality Health to better understand the pros, cons, aspects to consider and questions to ask when considering joining an ACO.
General APM Information
Additional resources and tools from CMS and other partners.
View this CMS fact sheet to find out more about the APM incentive payment in 2020, including who is eligible to receive it, how CMS determines your 2020 APM Incentive Payment, and other frequently asked questions and answers.
This FAQ from CMS answers questions regarding the All-Payer Combination Option and Other Payer Advanced Alternative Payment Models (APMs) under the QPP.
This one-page resource can assist MIPS APM Participants with their reporting for Performance Year 2020. Please check with your ACO/APM leadership to ensure that all the performance categories are adequately
This CMS website includes a wealth of information for ACOs - including three toolkits:
- Beneficiary Engagement Toolkit (PDF)
- Care Coordination Toolkit (PDF)
- Provider Engagement Toolkit (PDF)
This CMS resource provides an overview of the interactions between the Medicare Shared Savings Program (SSP) and the Quality Payment Program (QPP) during the 2020 performance period.
This CMS fact sheet displays the comprehensive list of Alternative Payment Models (APMs) for the 2020 and 2019 performance periods.
This CMS fact sheet shows the improvement activities performance category score they will assign participants in each MIPS APMs for the 2020 performance year.
This tool from the Health Care Payment Learning & Action Network is designed to help health care stakeholders navigate the inherent challenges and opportunities in APM implementation. It contains key insights, promising practices, and the most current strategies for designing and implementing successful APMs, delivered via an interactive web experience.
View this informative guide on APMs from the American Medical Association and the Center for Healthcare Quality and Payment Reform.
The electronic Clinical Quality Improvement (eCQI) page on the eCQI Resource Center offers tools and resources that provide a foundation for the development, testing, certification, publication, implementation, reporting, and continuous evaluation of quality measures and their improvement. You can refine the tool list by selecting a category of interest and/or a role that best describes your needs, or you can also click a specific tool from the list below to view additional details.
Mountain-Pacific Quality Health's electronic Clinical Quality Improvement (eCQI) toolkit utilizes aspects of an agile delivery cycle, which focuses on achieving value added changes quickly and efficiently, one change at a time. These systematic improvement cycles are called "sprints." The goal of each sprint is to provide value added results for your organization approximately every 2-6 weeks and is based on the PDSA iterative quality improvement cycle.
Learn more about payment reform with this comprehensive guide from the Center for Healthcare Quality and Payment Reform.
MIPS Tips: MIPS in a COVID-19 World (recording)
MIPS Tips: MIPS in a COVID-19 World (slides)
Many important issues and considerations face billing and coding staff when thinking about MIPS. This webinar is for office managers and billing and coding staff who want to learn more about MIPS billing and coding and how it can help your practice and clinicians improve their MIPS scores.
MIPS Tips: 2019 Year-End Readiness (slides)
Learn how to use your Cost category data to achieve better health and lower cost.
MIPS Tips: QPP for New Clinicians or Practice Managers — April 2019 (recording)
This session focuses on MIPS reporting by sharing information from the 2017 feedback reports.
This webinar focuses on the security risk assessment (SRA), which is a common audit failure in the promoting interoperability performance category. Presenters help you learn how to ensure your clinic has completed it accurately.
CMS publishes an updated set of administrative rules regarding QPP each year. In this session we review the most recent set of rules affecting the 2019 Performance Year.
This session offers a refresher on basic reporting requirements, instructions for making sure your EIDM account is ready to go and tactics for avoiding the disincentive (get to at least 15 points).
Review of the Cost category measures with an emphasis on how HCC coding is used for risk scoring. Risk scoring affects the expected cost and can have a significant impact on the ratios used for scoring.
This session focuses on using QPP and feedback reports for improvement and innovations in your clinic/organization.
MIPS Tips: Feedback Reports — Aug. 16, 2018 (recording)
MIPS Tips: MIPS & Cybersecurity: April 12, 2018 (recording)
MIPS Tips: March 28, 2018 (recording)
MIPS Tips: March 28, 2018 (slides)
MIPS Tips: March 8, 2018 (recording)
MIPS Tips: March 8, 2018 (slides)
MIPS Tips: Feb. 28, 2018 (recording)
MIPS Tips: Feb. 28, 2018 (slides)
MIPS Tips: Feb. 8, 2018 (recording)
MIPS Tips: Feb. 8, 2018 (slides)
MIPS Tips: Jan. 24, 2018 (recording)
MIPS Tips: Jan. 24, 2018 (slides)
MIPS Tips: Jan. 11, 2018 (recording)
MIPS Tips — Jan. 11, 2018 (slides)
MIPS Tips: Q&A Overview — Jan. 11, 2018: All of the questions and answers that were discussed during the Jan. 11, 2018, MIPS Tips session
Learn what it means to participate in MIPS with a test, partial and full reporting submission, and the benefits to participating to the greatest extent possible this year. Leave the session with a clear plan for gathering and reporting your performance data in each MIPS category. The first part of this session includes a review of all the steps you need to take to report for 2017. The second half is an open question-and-answer session with MIPS experts.
This session includes information on using the eCQI process to select areas for improvement and how to use a methodology to guide the improvement process.
In-depth session on how to score each category.
This session offers a deeper dive into two components of the MIPS portion of QPP, including costs and advancing care information. We review tools you can use today to assess your costs, along with ways to improve interoperability.
This session offers a deeper dive into the MIPS portion of QPP, including information on how you can be successful in the MIPS program, how to choose quality measures, how to improve quality measures, documentation and reporting, and how to complete an improvement activity.
QPP Webinar Series: QPP Overview — May 9, 2017 (recording)
Broad overview of the QPP program including who it impacts, what it is, when it will start, how it fits into the big picture and how to be successful in the QPP program.
Our specialty packets contain applicable measures for the Quality, Promoting Interoperability and Improvement Activities categories along with helpful scoring information. Use these as a starting point for your 2020 MIPS action plan or to review your current plan to confirm you are on the right track.
CMS Specialty Packets
These specialty packets from CMS highlight measures and activities for MIPS performance categories that apply to MIPS eligible clinicians in 2020.