QPP Roundup: August 2019

QPP Roundup: August 2019

Providing monthly updates on PAI's activities and QPP news for you and your practice.



QPP Tip of the Month: Review Your QP Status for Advanced APM Participation

The third snapshot period for determining 2019 Qualified Participant (QP) status will end on August 31st. Physicians part of an Advanced Alternative Payment Model (APM) who achieve QP status (based on number of patients or payments received through an Advanced APM) in 2019 will automatically qualify for a 5% positive payment adjustment in 2021. CMS uses three snapshot periods to determine QP status.

You can look up your current QP participation status from the first snapshot period here using the Quality Payment Program (QPP) participation status tool.


For more information on Advanced APMs, QP status designation, as well as CMS performance thresholds, please review PAI’s Advanced APM Overview and Advanced APM Resource Navigation Tool.



CMS Proposes Changes for QPP Year 4 and CY 2020 Medicare Physician Fee Schedule

On July 29th, CMS released a proposed rule on CY 2020 updates to the Medicare Physician Fee Schedule (MPFS) and QPP. A summary of key proposed changes to the 2020 QPP performance year include:

  • Increased MIPS Performance Threshold – CMS proposed increasing the performance threshold from 30 points to 45 points and the exceptional performance bonus threshold from 75 points to 80 points.

  • MIPS Category Weights – CMS proposed decreasing the weight of the Quality category from 45% to 40%, while increasing the weight of the Cost category from 15% to 20%. The Promoting Interoperability and Improvement Activities categories would remain unchanged (25% and 15% respectively).

  • Technical Changes to Performance Categories – CMS proposed distinct technical changes to each performance category.

PAI will comment on these and additional proposals in the MPFS and the QPP and encourage physicians to contact their state medical societies with any feedback. Review PAI’s past comments to QPP proposals here.

CMS MPFS Proposals

  • Changes to office/outpatient Evaluation and Management codes – CMS proposed eliminating the blended rate for level 2-4 office/outpatient E/M visits and implementing a new criterion for setting E/M levels based solely on medical decision-making and time spent with the patient. CMS also proposed consolidating current procedural terminology coding from five levels to four levels for office/outpatient E/M visits for new patients and current add-on codes.

  • Changes and additions to Chronic Care Management service codes (CCM) – CMS proposed several changes to CCM codes that would allow physicians and other clinicians to bill incrementally based on time and resources required to treat patients with complex illnesses and add a new Principle Care Management services code family focused on managing a single serious and high-risk condition.

  • Scope-of-service and supervision requirements – CMS proposed deferring to state law for physician assistants (PAs) and treating the supervision requirement for PAs as satisfied if a PA furnishes services in accordance with state law and state scope-of-practice rules.

  • Stark Advisory Opinion Process – CMS is soliciting stakeholder input on this.

For additional details, please see the Proposed Rule, CMS Press Release, QPP Proposed Rule Factsheet, and the MPFS Proposed Rule Factsheet.



CMS QPP Updates

CMS posted new resources and fact sheets to its QPP Resource Library:

Additional resources on MIPS and Advanced APMs are available on PAI's QPP Resource Center and the CMS QPP Resource Library.