Determine Your Practice’s QPP Reporting Requirements With MACRA Decision Tree

Sep 06, 2017

Believe it or not, we’re more than halfway through the first year of the Quality Payment Program (QPP), which is changing the way physicians are reimbursed for Medicare Part B services and moving the United States from a volume- to a value-based health care delivery system.

QPP, established by the Medicare Access and CHIP Reauthorization Act (MACRA), is being implemented in oncology practices across the country. 2017 and 2018 are transition years with minimal reporting requirements; over time, quality reporting will require a heavier lift to avoid financial penalties.

Under QPP, Medicare providers are transitioning to either the Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (APM). While ASCO, the Centers for Medicare & Medicaid Services (CMS), and other stakeholders have released robust guidance on successfully complying with QPP, it can be more difficult to find tailored information addressing your practice’s specific circumstances during this transition period.

ASCO has therefore developed a MACRA Decision Tree tool to help practices find precise information on their QPP participation status, and any applicable MIPS exceptions, based on practice- or provider-specific information. With answers to a few basic questions, the tool can help determine the participation status of everyone in a practice, identify performance categories from which providers may be exempt or have lessened reporting requirements, and identify differences in reporting requirements for specific individuals depending on whether they choose individual or group reporting.

Specifically, the decision tree can answer:

  • Am I subject to MACRA and QPP?
  • Do I participate in a CMS-recognized Advanced APM?
  • Am I a MIPS-eligible clinician?
  • Do I participate in a MIPS APM (a specific type of APM that does not meet the requirements to be an Advanced APM)?
  • Do any exemptions or special circumstances apply to me (including factors such as your professional designation, number of Medicare patients seen annually, practice site[s], and the size of your practice)?
  • Do these exemptions or special circumstances affect decisions regarding individual versus group reporting?

Visit ASCO.org to try the decision tree and to check out the rest of ASCO’s online QPP toolkit.

Visit ASCO in Action for the latest on implementing MACRA in your practice and for all breaking cancer policy news.

A Quick Primer on MACRA Concepts

MACRA: Medicare Access & CHIP Reauthorization Act of 2015. Passed by the U.S. Congress in 2014, it repealed the Sustainable Growth Rate (SGR) and replaced it with the QPP, a new method of paying clinicians who bill Medicare Part B.​

QPP: Quality Payment Program. Applies to most clinicians who bill Medicare Part B, and consists of 2 tracks: 1) participation in an Advanced APM, or 2) participation in MIPS.​

APM: Alternative Payment Model. A method of payment that links payment to performance. CMS has designated for 2017 which of these are Advanced APMs and which are MIPS APMs.​

Advanced APM: Advanced Alternative Payment Model. A specific type of APM which links payment to performance, requires the use of certified electronic health records, and includes financial risk for the practice. Clinicians in these models are exempt from MIPS.​

MIPS: Merit-based Incentive Payment System. Payment is still fee-for-service (FFS) but fee schedule amounts for individual clinicians or groups are adjusted based on performance 2 years prior. 

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