Medicare Compliance & Reimbursement

Hint: Performance Year and Payment Year are not the same.

Even though the Quality Payment Program (QPP) has been around for a while now, many Medicare providers still struggle with the basics. Confusion exists because of the annual revamp of the program, including category changes, updated thresholds, and new requirements.

That’s why it is incredibly important to go over the basics with your staff annually to ensure everyone knows the updates. Read on for a quick quiz to test your QPP savvy.

1. What is the first Performance Year of the QPP?

a. 2016
b. 2017
c. 2018
d. 2019

2. What is the Payment Adjustment Year for Merit-Based Incentive Payment System (MIPS) 2017?

a. 2017
b. 2018
c. 2019
d. 2020

3. As of 2019, what are currently the four performance categories that MIPS-eligible clinicians submit measures in?

a. Cost, Improvement Activities, Quality, Meaningful Use
b. Cost, Improvement Activities, Quality, Advancing Care Information
c. Cost, Improvement Activities, Quality, Promoting Operability
d. None of the above

4. What did the QPP replace?

a. The Physician Fee Schedule
b. Advanced Alternative Payment Models (APMs)
c. MACRA
d. Sustainable Growth Rate (SGR) law

5. Who is not considered a MIPS-eligible clinician, according to the QPP criteria?

a. Qualified audiologist
b. Pediatric nurse
c. Primary care physician
d. Physical therapist

6. What is the low-volume threshold for MIPS 2019 participation?

a. Bill at least $90k in Part B allowed charges, administer care to at least 200 Part B beneficiaries, and provide at least 200 covered fee-schedule services
b. Bill at least $30k in covered professional services or see 100 Part B patients
c. Bill at least $50k in Part B services and see 200 patients
d. None of the above

7. What is the positive/negative penalty adjustment starting in 2020?

a. +/-5
b. +/-7
c. +/-9
d. +/-10

8. How long should MIPS-eligible clinicians keep their MIPS data files and medical records in case of an audit?

a. 3 years
b. 5 years
c. 6 years
d. 10 years 

9. In its QPP 2020 proposal, the Centers for Medicare & Medicaid Services (CMS) proposed to reweight two of the performance categories, greatly impacting the MIPS final score. Which two MIPS performance categories are slated for reweighting in PY 2020 and what are their new weights?

a. Cost increases to 20 points and Improvement Activities increases to 50
b. Quality decreases to 40 and Cost increases to 20
c. Promoting Interoperability decreases to 75 and Quality increases to 25
d. Cost decreases to 40 and Promoting Interoperability increases to 40

10. What action might get your MIPS file pulled for an audit in 2020?

a. Data cloning on your EHR
b. Lack of documentation on the Promoting Interoperability security assessment
c. Not submitting enough measures in the Quality category
d. All of the above

Answers: 1) b; 2) c; 3) c; 4) d; 5. b; 6. a; 7. c; 8. c; 9. b; 10. d