American Society of Hematology

MACRA Frequently Asked Questions

If you are a physician, physician assistant, nurse practitioner, clinical nurse specialist, or a certified registered nurse anesthetist billing Medicare Part B, you must participate in the Quality Payment Program (QPP). If you are not in an Advanced Alternative Payment Model (APM), you must participate in the Merit-based Incentive Payment System (MIPS).

You may be excluded from MIPS if you are:

  • Newly-enrolled in Medicare, meaning you enrolled for the first time during the performance period;
  • You are below the low-volume threshold, meaning your Medicare Part B allowed charges are less than or equal to $90,000 a year OR you see 200 or fewer Medicare Part B patients a year; or
  • You are significantly participating in Advanced APMs, meaning you receive 25 percent of your Medicare payments or see 20 percent of your Medicare patients through an Advanced APM.

CMS estimates that 540,000 clinicians will fall below the low-volume threshold, so be sure to check your participation status on the QPP website.

MIPS consolidates three existing programs, Meaningful Use (MU), the Physician Quality Reporting System (PQRS), and the Value-Based Modifier (VBM), all of which will sunset at the end of 2018 when the final penalties are assessed. MIPS is made up of four performance categories, each of which will be combined to create a clinician's or group's Composite Performance Score. The categories and corresponding weights for 2017 are listed below:

  • Quality (50%)
  • Advancing Care Information (25%)
  • Clinical Practice Improvement Activities (15%)
  • Cost (10%)

Bonuses and penalties will be assessed two years after each performance period. Payment adjustments for the second performance year (2018) will be applied in 2020.

The Centers for Medicare and Medicaid Services (CMS) deemed 2017 a transition year for MIPS, allowing participating clinicians to “pick their pace.” To avoid a penalty in 2020, clinicians will have to report more quality information in 2018.

CMS finalized a performance threshold of 15 points for the 2018 performance period, an increase from the threshold of three points required in the first year of the program. Providers can reach the 15-point threshold through multiple pathways, many of which only require partial MIPS reporting. For instance, small practices could reach the performance threshold by reporting just three quality measures or one quality measure and one medium weighted improvement activity along with receiving the five-point small practice bonus. Any physician or practice could submit the maximum number of improvement activities and reach the 15-point threshold because the improvement activities performance category is worth 15 percent of the final score.

Scoring between 15 points and 69 points will allow a clinician to avoid a negative payment adjustment and may provide a slight positive payment adjustment.

The additional performance threshold for exceptional performance will remain at 70 points, the same as for the transition year. A provider whose MIPS score reaches 70 points or above will receive an additional, escalating positive adjustment ranging between 0.5 percent and 10 percent.

It is important to note that for the quality and cost categories CMS is requiring a full calendar year reporting period for 2018. However, no quality data is reported for the cost category; CMS extracts the information from claims. The performance period for improvement activities and advancing care information is a minimum of a continuous 90-day period within the calendar year up to and a full year as a maximum.

Clinicians may choose to report all of the required data for a full year. To learn what the requirements are for each performance category, refer to the chart in the “How do clinicians report their data?” question below.

Please note: Not participating in the QPP or scoring below 15 points for 2018 will result in a negative 5 percent payment reduction in 2020.

You can report as an individual, using a National Provider Identifier (NPI) number and Tax Identification Number (TIN) where they reassign benefits, or you can report as a group, requiring two or more clinicians (identified by their NPIs) who have reassigned their billing rights to a single TIN or submitting as an Alternative Payment Model (APM) entity. Reporting methods vary for each performance category and for the method of reporting. See details in the table below.

Performance CategoryIndividualGroup
QCDR (Qualified Clinical Data Registry)
Qualified Registry
Administrative Claims 
CMS Web Interface (groups of 25 or more)  
CAHPS for MIPS Survey 
Advancing Care Information
Qualified Registry
EHR Vendor
CMS Web Interface (groups of 25 or more) 
Improvement Activities
Qualified Registry
EHR Vendor

The Quality performance category replaces the Physician Quality Reporting System (PQRS). For 2018, this category will be weighted 50 percent.

CMS requires a full calendar year of reporting for the Quality Performance Category in 2018. (Refer to the question "What do clinicians have to do for 2018?" for more information.)

To meet the full reporting requirements for this category:

  • Report on at least six of the available quality measures, including one outcome measure. If an outcome measure is not available that is applicable to your specialty or practice, choose another high-priority measure. There is currently no specialty measure set available for hematology or oncology.
  • Clinicians are required to report on 60 percent of all patients for all reporting mechanisms except for the web interface and CAHPS.
  • Bonus points are available for submitting an additional high-priority measure or for using Certified Electronic Health Record Technology (CEHRT) to submit measures to registries or CMS.

Explore the measures here.

The Advancing Care Information (ACI) performance category replaces the Medicare Meaningful Use program. For 2018, the ACI performance category will be weighted 25 percent.

For the 2018 performance year, clinicians must report a minimum of a continuous 90-day period within the calendar year up to and a full year as a maximum. Clinicians may continue to use the 2014 edition and/or 2015-certified electronic health record technology (CEHRT) for the 2018 performance year. A bonus will be given for those clinicians using only 2015 CEHRT.

To meet full reporting requirements for the ACI performance category:

  • Report data on all five base score measures. The base score will account for 50 percent of the ACI performance category score. Clinicians must meet criteria for all base score measures to receive any score in this category.
  • Report data on additional performance score measures. The performance score measures will allow clinicians to earn an additional 50 percent for their score.

Learn more about the measures here.

The Improvement Activities performance category is a new category under the Quality Payment Program. For 2018, the Improvement Activities performance category will be weighted 15 percent.

For the 2018 performance year, clinicians must report a minimum of a continuous 90-day period within the calendar year up to and a full year as a maximum.

To meet full reporting requirements for the Improvement Activities performance category:

  • Attest completion of two high-weighted or at least four medium-weighted activities, or a combination of high- and medium-weighted activities to total 40 points. An activity must be performed for at least 90 days during the performance period to receive credit. Patient-centered medical homes (PCMH) will automatically receive full credit.
  • Eligible clinicians or groups must submit data on improvement activities in one of the following ways:
    • Qualified registries
    • EHR submission mechanisms
    • Qualified Clinical Data Registries
    • CMS web interface
    • Attestation

Please note: Groups with fewer than 15 participants or those in a rural or health professional shortage area will only have to attest for one high-weighted activity or two medium-weighted activities.

To explore improvement activities, click here.

The Cost performance category replaces the Value-Based Modifier program, and for the 2018 performance year and the corresponding 2020 payment year, this category will be weighted at 10 percent. CMS will assess clinicians on a full calendar year of reporting for the Cost performance category in 2018. Total per capita costs for all Attributed Beneficiaries measure and the Medicare Spending per Beneficiary (MSPB) measure will be used to determine your Cost category score in 2018.

CMS is in the process of developing new episode-based measures with significant clinician input and believes it would be more effective to introduce these new measures over time. CMS intends to provide performance feedback on the MSPB and total per capita cost measures by July 1, 2018, as well as feedback on newly developed episode-based cost measures sometime next year.

March 31, 2018: Data submission deadline for MIPS data collected in performance year 2017. Remember, as an ASH member, you can sign up to report your data through MIPSPRO, a 2017 Qualified MIPS Registry.

If you are participating in the Oncology Care Model (OCM) and you are not a qualifying APM participant (QP), you may still be required to participate in MIPS; this is known as a MIPS APM. Those who are designated as Partial QPs based on the number of patients and revenue in the Advanced APM have an option to participate in MIPS. For details on reporting, see below:

  • Report Quality measures as required by the terms of the OCM.
  • No additional Improvement Activities are required. Practices will receive the full score for this category by participating in the required activities for the OCM.
  • OCM practices must comply with the Advancing Care Information requirements under MIPS.

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