QPP Fast Facts in 5 Minutes
May 2019 Fast Facts
The Medicare Promoting Interoperability Program Hardship Exception Application for Eligible Hospitals and Critical Access Hospitals is Now Available
The Centers for Medicare & Medicaid Services (CMS) requires that all eligible hospitals and critical access hospitals (CAHs) use 2015 Edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability Programs. CMS mandates downward payment adjustments be applied to eligible hospitals and CAHs that are not meaningful users of CEHRT.
Eligible hospitals and CAHs may be exempt from Medicare penalties if they can show that compliance with the requirement for being a meaningful EHR user would result in a significant hardship. To be considered for an exemption, eligible hospitals and CAHs must complete a hardship exception application and provide proof of hardship.
The application for eligible hospitals and CAHs is now available onlineas a web-based application and can be found here.
Hardship Exception Application Details
- The deadline for CAHs to submit an application is November 30, 2019.
- You may now submit hardship applications electronically here.
- If an electronic submission is not possible, you may verbally submit your application over the phone by calling the QualityNet Help Desk at (866) 288-8912.
- The deadline for eligible hospitals to submit an application is July 1, 2019.
Developments in the QPP Look Up Tool for APM Entities
The Centers for Medicare and Medicaid Services (CMS) has added secure access to the Quality Payment Program Eligibility & Reporting page for Alternative Payment Models (APMs). Alternative Payment Models (APM) Entities have requested the ability to download a participant list of their clinicians. APM entities are the organizations that participate in the Alternative Payment Model and are not always the billing organization.
The new capabilities will allow APM entities to download a list of their clinicians. The APMs supported are the Shared Savings Program, Next Generation ACO, and Comprehensive Primary Care Plus models.
An additional announcement will be shared when the login capabilities include the Comprehensive ESRD Care and Oncology Care Models, in early summer 2019.
Updated eCQM Specifications and eCQM Materials for 2020 Reporting Now Available
The Centers for Medicare & Medicaid Services (CMS) has posted the electronic clinical quality measure (eCQM) specifications for the 2020 reporting period for Eligible Hospitals and Critical Access Hospitals, and the 2020 performance period for Eligible Professionals and Eligible Clinicians. CMS updates the specifications annually to align with current clinical guidelines and code systems so they remain relevant and actionable within the clinical care setting. These updated eCQMs are to be used to electronically report 2020 clinical quality measure data for CMS quality reporting programs. Measures will not be eligible for 2020 reporting unless and until they are proposed and finalized through notice-and-comment rulemaking for each applicable program.
CMS has updated eCQMs for potential inclusion in the following programs:
- The Hospital Inpatient Quality Reporting (IQR) Program
- The Medicare and Medicaid Promoting Interoperability Programs
- Quality Payment Program: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs)
- Comprehensive Primary Care Plus (CPC+)
Where to Find the Updated eCQM Specifications and Materials
The updated eCQM specifications are available on the Electronic Clinical Quality Improvement (eCQI) Resource Center for Eligible Hospitals and Critical Access Hospitalsand Eligible Professionals and Eligible Cliniciansunder the 2020 Reporting/Performance Year. Other eCQM materials, including the Guide for Reading eCQMs, eCQM Logic and Implementation Guidance, tables of eCQMs, and technical release notes, are also available at the same locations. The Guide to Reading eCQMsand eCQM Logic and Implementation Guidancehave been updated based on end user feedback and CMS continues to update these guides to assist stakeholders in understanding and implementing eCQMs.
Where to Find the 2020 eCQM Value Sets, Direct Reference Codes, and Terminology
The 2020 reporting/performance period eCQM value sets are available through the National Library of Medicine’s Value Set Authority Center (VSAC). Sign up for a Unified Medical Language System (UMLS) accountto access the value sets. The value sets are available as a complete set, as well as value sets per eCQM. The direct reference codes specified within the eCQM HQMF files are also available in a separate file for download on the VSAC Downloadable Resources page.
Do you plan to use the CMS Web Interface and /or administer the CAHPS for MIPS Survey?
Registration is required and must be completed by July 1, 2019. Refer to the 2019 Registration Guide for the CMS Web Interface and CAHPS for MIPS Surveyfor step-by-step instructions. If your group reported quality data for MIPS 2018 performance period via CMS Web Interface, CMS automatically registered your group for 2019. You may edit or cancel your registration during the registration period. Automatic registration does not apply to the CAHPS for MIPS Survey.
CMS Releases All-Payer Guidance; Schedules Webinar on MIPS Group Participation
CMS is collecting information and documentation to determine whether payment arrangements qualify as Other Payer Advanced Alternative Payment Models (APMs) under the Quality Payment Program (QPP).
Payers with commercial payment arrangements may submit Other Payer Advanced APM determination requests for those payment arrangements. CMS has released a document to guide payers through the All Payer Submission formfor ease of submission and to facilitate accurate determinations by CMS. Commercial payment arrangements must be submitted by June 1, 2019 to be eligible for the 2020 Qualifying APM Participant (QP) Performance Period. For the 2020 QP Performance Period, payers may submit requests until June 1, 2019.
Please note that the submission through the Other Payer Advanced APM determination process is separate from the process of Medicare Health Plans (including Medicare Advantage plans) payment arrangements. The Medicare Health Plans application is occurring now through the Health Plan Management System(HPMS) bidding process with a due date the first week of June. The Other Payer Advanced APM determinations is occurring now through the Salesforce Portal (https://app1.innovation.cms.gov/qpp/qppLogin) with a due date of June 1, 2019.
The CMS Innovation Center recently announced the CMS Primary Cares Initiative, a new set of payment models that will transform primary care to deliver better value for patients throughout the healthcare system.
The CMS Primary Cares Initiative will provide primary care practices and other providers with five new payment model options, three of which are under the Direct Contracting (DC) path and two of which are under the Primary Care First path.
Direct Contracting Path:
Direct Contracting is a set of three voluntary payment model options aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS). The payment model options available under DC create opportunities for a broad range of organizations to participate with the CMS in testing the next evolution of risk-sharing arrangements to produce value and high quality health care.
Please attend one of the upcoming informational sessions to learn more about Direct Contracting. During the one-hour event, you’ll hear from senior leaders and the team behind Direct Contracting about the model’s aims and requirements, benefits of participation, and application process. For your convenience, CMS will offer two informational sessions that will include a live question and answer session. Both will be recorded. Session information and registration links are included below:
· Informational Session 1: Thursday, May 2nd at 3 PM EDT: Register to attend
· Informational Session 2: Tuesday, May 7th at 3 PM EDT: Register to attend
Primary Care First Path:
The Primary Care First payment model options will test whether financial risk and performance-based payments that reward primary care practitioners and other clinicians for easily-understood, actionable outcomes will reduce total Medicare expenditures, preserve, or enhance quality of care, and improve patient health outcomes. Primary Care First also includes a payment model option that provides higher payments to practices that specialize in care for high need patients, including those with complex, chronic needs and seriously ill populations (SIP).
Please attend one of the upcoming informational sessions to learn more about Primary Care First. During the one-hour event, you’ll hear from senior leaders and the team behind Primary Care First about the model aims, requirements, benefits of participation, and application next steps. For your convenience, CMS will offer multiple informational sessions. Session information and registration links are included below:
· Informational Session 3: Thursday, May 16th at 12 PM EDT: Register to attend
· Informational Session 4: Thursday, May 16th at 3 PM EDT: Register to attend
January 2019 Fast Facts
Happy New Year! Ready for 2019?
Check out all the 2019 Resources to help you be successful this year. Simply go to the CMS QPP Resource Library to find the 2019 Final Rule and learn more. We also encourage you to scroll down on this page and utilize the filter tool by performance year to find fact sheets, user guides, measure specification criteria and other information as you navigate through this program. Have more questions or need support? Please reach out by clicking QPP Help and Support to get connect to the right support for you!
Snapshot of 2018 Qualifying APM Participant and MIPS APMs Data
The Centers for Medicare & Medicaid Services (CMS) updated its Quality Payment Program Participation Status Tool based on calculations from 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 and August 31, 2018. As a reminder, the tool includes 2018 Qualifying APM Participant (QP) and MIPS APM status. For those in the Medicare Shared Savings Program, a fourth snapshot date, December 31, will apply to you. It’s used for determining which eligible clinicians are participating in a MIPS APM for purposes of the APM scoring standard.
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.
To learn more about how CMS determines QP and MIPS APM status for each snapshot, please view the QP Methodology Fact Sheet.
Year 2 Data Submission Period is Open!
The QPP data submission period for Year 2 (2018) began on January 2, 2019. You can log-in to the QPP website to upload data files and attest for Improvement Activities and/or Promoting Interoperability. Data may be added and submitted by April 2, 2019, at 7:00 p.m. CST to receive credit. * Please check with registries for specific submission deadline dates*
The Colorado QPP Office Hours webinar will focus on 2018 MIPS Data submission, please register using the link provided below under upcoming events to learn more!
When is CMS Web Interface Submission Period?
If you are submitting data through the CMS Web Interface, your submission period is January 22nd, 2019 – March 22nd, 2019. Click here to watch a YouTube on how to submit your data successfully!
New QPP Log-In System Replaces EIDM
CMS is creating a one-stop shop for clinicians and practices looking to manage their data from one location. Going forward, users will manage their reporting access; including user IDs and passwords, directly through the QPP website.
• Current users will log-in using your regular EIDM credentials.
• New users will create their account from the QPP log-in page by clicking on the "Register" link. This will direct new users to CMS' new secure identity management portal - the HCQIS Access Roles and Profile (HARP) system.
More information for creating a new account is available in the QPP Access User Guide.
January 22nd, 2019; Noon to 1pm MST
Colorado QPP Coalition Office Hours: Please join us for our January webinar to learn about 2018 MIPS Data Submission and Reporting guidance. Our speaker this month is Lauren O’Kipney with CORHIO. We will spend the first 30-40 minutes providing information on how to successfully report for the 2018 QPP performance period, and save plenty of time for open discussion, questions and comments. Register Now
February 13; Noon to 1 p.m., CT
Telligen QPP: Developing Provider Collaborative Care Agreements
Please join Telligen's guest speaker, MGMA's Pamela Ballou-Nelson, as she outlines a framework for better communication and safer transitions of care between primary care and specialty providers. Register Now