The Centers for Medicare & Medicaid Services (CMS) recently updated its Quality Payment Program Participation Status Tool to include 2018 Qualifying APM Participant (QP) and MIPS APM status. The tool has been updated based on calculations from the first snapshot of data from APM entities. The first snapshot includes data from Medicare Part B claims with dates of service between January 1 and March 31, 2018.

Later this year, CMS will release and announce the second and third QP and MIPS APM status data based on snapshots of claims between January 1 and August 31, 2018.  To learn more about how CMS determines QP and MIPS APM status for each snapshot, please view the QP Methodology Fact Sheet. 

What Does QP Status and MIPS APM Status Mean?

If you qualify as a QP, this means you are:

  • Eligible for the 5% APM incentive bonus, and
  • Exempt from participating in MIPS.

Note: If you are in participating in a MIPS APM (and do not qualify as a QP or Partial QP), you will most likely need to participate in MIPS, but will be subject to the APM Scoring Standard. Check the Quality Payment Program Participation Status Tool to see if you’re eligible for MIPS in 2018.

What APMs are Included in the Quality Payment Program Participation Status Tool?

The updated Quality Payment Program Participation Status Tool includes the following 2018 Advanced APMs and MIPS APMs:

  • Comprehensive Care Joint Replacement (CJR) Payment Model (Track 1 – CEHRT)
  • Comprehensive ESRD Care (CEC) – Two-Sided Risk
  • Comprehensive Primary Care Plus (CPC+)
  • Next Generation Accountable Care Organization (ACO) Model
  • Medicare ACO Track 1+ Model
  • Medicare Shared Savings Program – Track 1
  • Medicare Shared Savings Program – Track 2
  • Medicare Shared Savings Program – Track 3

How Do I Check My QP or MIPS APM Status?

To view your QP or MIPS APM status at the individual level:

To check your group’s 2018 eligibility at the APM entity level:

  • Log into the CMS Quality Payment Program website with your EIDM credentials
  • Browse to the Taxpayer Identification Number affiliated with your group
  • Access the details screen to view the eligibility status of every clinician based on their NPI

About Author

Healthcentric Advisors
As the New England Quality Payment Program Support Center, Healthcentric Advisors assists New England-based physician and other eligible clinical practices to prepare for and participate in the new Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).