Oncology & Hematology Coding Alert

Medicare created the Quality Payment Program (QPP) as part of 2015's Medicare Access and CHIP Reauthorization Act (MACRA) as an effort to halt rising Medicare costs. The QPP has two tracks that eligible clinicians (ECs) can choose from: MIPS and APM.

Most ECs will participate in MIPS-the Merit-Based Incentive Payment System. MIPS supplements your current fee-for-service payment system with either positive or negative payment adjustments based on your performance in four categories:

• Quality (similar to Physician Quality Reporting System)
• Resource Use/Cost (not the cost to you, but the cost to Medicare)
• Clinical Practice Improvement Activities
• Advancing Care Information (similar to Meaningful Use)

Your performance in these four categories is aggregated into your MIPS Composite Performance Score. That score, on a scale from 0-100, is placed on a continuum along with all other participating physicians. Your place on the continuum corresponds to a payment adjustment amount. That amount depends on where your score lies relative to a "performance threshold," the nationwide mean of all participants.

A few points to remember about the performance threshold:

• Payment adjustments are neutral (zero dollars) at the performance threshold.
• Perform above the threshold, and you'll receive a positive payment adjustment.
• Perform below it, and receive a negative adjustment.

Payment adjustments are applied two years after the performance year. For performance year 2018, you'll see your payment adjustment reflected in 2020's reimbursement.

Resource: For an in-depth coverage of Quality Payment Program updates for CY 2108, see the story on page 1.