The Centers for Medicare & Medicaid Services (CMS) updated its Quality Payment Program Participation Status Lookup Tool based on the third snapshot of data from Alternative Payment Model (APM) entities.

The third snapshot includes data from Medicare Part B claims with dates of service between January 1, 2020 and August 31, 2020. The tool includes 2020 Qualifying APM Participant (QP) and Merit-based Incentive Payment System (MIPS) APM participation status.

To learn more about how CMS determines QP and APM participation status for each snapshot, please view the 2020 Learning Resources for QP Status and APM Incentive (zip) or visit the Advanced APMs webpage on the QPP website.

What Does QP 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.

How Do I Check My QP or APM Participation Status?

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

To check your 2020 eligibility at the APM entity level:

  • Log into the CMS Quality Payment Program website. Learn how by downloading the QPP Access User Guide.
  • Browse to the Taxpayer Identification Number(s) affiliated with your entity.
  • Access the details screen to view the eligibility status of every clinician based on their NPI.

A Look Ahead at 2021: QP Thresholds

What are the QP Thresholds for 2021?

For QP status:

  • The payment amount threshold is increasing from 50% in 2020 to 75% in 2021.
  • The patient count threshold is increasing from 35% in 2020 to 50% in 2021.

For Partial QP status:

  • The payment amount threshold is increasing from 40% in 2020 to 50% in 2021.
  • The patient count threshold is increasing from 25% in 2020 to 35% in 2021.

If you qualify as a Partial QP, you will be able to choose whether or not you want to participate in MIPS, but you will not be eligible for the 5% incentive payment. To learn more, please view the 2021 QP Quick Start Guide.

Learn More

For more information on APMs, visit the QPP APM webpages. For a comprehensive list of APMs and additional materials, visit the QPP Resource Library.

For more information on QP thresholds:

Questions?

Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, please consider calling during non-peak hours—before 10:00 a.m. and after 2:00 p.m. ET.

  • Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

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