NEW! The QPP Performance Year 2020 Proposed Rule is now available

The approach for the 2020 Performance Year is to maintain many of the requirements from the 2019 Performance Year, while providing some needed updates to both the MIPS and Advanced APM tracks to continue reducing burden, respond to feedback heard from clinicians and stakeholders, and align with statutory requirements.


  • increase the performance threshold (which is the minimum number of points to avoid a negative payment adjustment) from 30 points in 2019 to 45 points in 2020 and 60 points in 2021
  • increase the additional performance threshold for exceptional performance to 80 points in 2020 and to 85 points in 2021
  • Reduce the Quality performance category weight to 40 percent in 2020, 35 percent in 2021, and 30 percent in 2022
  • Increase the Cost performance category weight to 20 percent in 2020, 25 percent in 2021, and 30 percent in 2022

Review the 2020 QPP proposed rule Overview Fact Sheet for details (click here for direct PDF download).

How do I comment on the CY 2020 proposed rule?

The proposed rule includes directions for submitting comments. Comments must be received within the 60-day comment period, which closes on Sept. 27, 2019. When commenting refer to file code: CMS-1715-P.

FAX transmissions won’t be accepted. Use one of the following ways to officially submit your comments:

  • Electronically through
  • Regular mail
  • Express or overnight mail
  • Hand or courier

The proposed rule can be accessed through “Regulatory Resources” section of the QPP Resource Library.

MIPS Data Validation and Audit

Guidehouse has been contracted by Centers for Medicare and Medicaid Services (federal CMS) to conduct the data validation and audit (DVA) work for the Merit-based Incentive Payment System (MIPS). MIPS-eligible clinicians, groups and virtual groups are required to provide substantive, primary source documents as requested by the federal CMS. MIPS DVA will be conducted in 2019 for the 2017 and 2018 Performance Years (PY). It will cover the Quality, Improvement Activities (IA), and Advancing Care Information (ACI)/Promoting Interoperability (PI) performance categories.

The number of measures and activities selected for DVA from each MIPS performance category will mirror the weighting for scoring. For example, for PY 2017 approximately 60% of the total audits will be for Quality, 15% for IA, and 25% for ACI (now PI), and for PY 2018 approximately 50% of the total audits in a submission category will be for Quality, 15% for IA, and 25% for PI.

What is the 2019 Complex Patient Bonus?

The Complex Patient Bonus is added to the MIPS final score and based on the overall medical complexity and social risk for the patients treated by a clinician or group. The Complex Patient Bonus awards up to five bonus points, which is added to your final score, based on the complexity of the patients you treat. This bonus is based on a combination of the average Hierarchical Condition Category (HCC) risk score of the beneficiaries treated and the proportion of dually eligible patients treated. This fact sheet will address who is eligible for the bonus, how the bonus is determined and calculated, and how it is applied to your MIPS final score

Reminder: Targeted reviews MUST be submitted by Sept. 30, 2019

The Targeted Review request form can be found on your performance feedback page in the QPP Portal.

Upcoming events!

August 27, 2019 CO QPP Coalition webinar; 2018 Feedback reports and Targeted Review. Register prior to event.

No federal CMS-sponsored upcoming webinars currently planned. Check out the courses available on the Medicare Learning Network (MLN) Learning Management System (LMS). You can earn Continuing Medical Education (CME) credits accredited by AMA while learning about the Quality Payment Program.

New QPP resources released!

Categories: Communications, LiveWire, Resources, Practice Management, Coding and Billing