Physician Payment: QPP and MACRA

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"> <a class="a2a_button_pinterest" aria-label="Pinterest" style="padding:0;"> <svg class="connect__social-icon" role="img" aria-label="pinterest"> <title> pinterest </title><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="/assets/img/common/svg-sprite.svg#social-pinterest"> </use> </svg> </a> </li> <li class="share-bar__item social-print a2a_kit a2a_kit_size_32 a2a_default_style" data-a2a-url="https://www.endocrine.org/improving-practice/macra" data-a2a-title="Physician Payment: QPP and MACRA" data-a2a-description="Explore information and resources to learn how the Quality Payment Program and MACRA affects your practice. "> <a class="a2a_button_print" aria-label="Print" style="padding:0;"> <svg class="connect__social-icon" role="img" aria-label="print"> <title> print </title><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="/assets/img/common/svg-sprite.svg#social-print"> </use> </svg> </a> </li> </ul> </section> <div class="rich-text end-page-header"> <h1>Physician Payment: QPP and MACRA</h1> <div class="meta"> <span class="meta__date">November 14, 2024</span> </div> </div> <div class="rich-text"> <section class="rich-text__embed l-pull-right"> <section class="end-image-block js-image-block"> <figure class="end-image-block__media" aria-labelledby="caption-c1ec5fd1-4884-43f6-b694-29ceb639e468"> <div class="end-image-block__image"> <picture> <source srcset="/-/media/endocrine/images/macra/qppwidget320x166.jpg?w=1290&hash=7B08B20D5CB7C3893078B076A10168A4 1x, /-/media/endocrine/images/macra/qppwidget320x166.jpg?w=2580&hash=63E6635BAB35BF2D30B98A253D13B768 2x" media="(min-width: 56.9375em )"></source> <source srcset="/-/media/endocrine/images/macra/qppwidget320x166.jpg?w=910&hash=5FA7B3FD7A26D8A3F9CB140D6F6A8AD6 1x, /-/media/endocrine/images/macra/qppwidget320x166.jpg?w=1820&hash=B6431949C7F649D1510717444E10878B 2x" media="(min-width: 29.4375em )"></source> <source srcset="/-/media/endocrine/images/macra/qppwidget320x166.jpg?w=470&hash=51B55F53009289A37A08ADECF15959E9 1x, /-/media/endocrine/images/macra/qppwidget320x166.jpg?w=940&hash=8D8248FBAEFA019D6AA11764DB7B82E4 2x" media="(max-width: 29.375em )"></source> <img src="/-/media/endocrine/images/macra/qppwidget320x166.jpg?la=en&h=669&w=1290&hash=05487B6CEB5AF9DD62822EDDCA9E5928" alt="qpp" style="width:100%" srcset="/-/media/endocrine/images/macra/qppwidget320x166.jpg?w=160&hash=BE77F4334F1A6B473D75AED7DBCBBBC4 1x, /-/media/endocrine/images/macra/qppwidget320x166.jpg?w=320&hash=A2760C19254EB52C6AF3DF28C9F6B88C 2x"> </picture> </div> <figcaption id="caption-c1ec5fd1-4884-43f6-b694-29ceb639e468"> </figcaption> </figure> </section> </section> <p style="margin-bottom: 0in;"><span>Review our notices, milestones and resources to help navigate payment changes in the Quality Payment Program (PPQ), the Medicare Access and CHIP Reauthorization Act (MACRA), and more. The Society is currently advocating for <a href="/-/media/endocrine/files/advocacy/2024-hill-day/2024_09_medicare_physician_payment_priorities_flyer_final.pdf">Medicare physician payment priorities.</a></span></p> <p style="margin-bottom: 0in;"><span> </span></p> <a name="2025FinalRule"></a> <h4>CY 2025 Medicare Physician Fee Schedule Final Rule</h4> <p>CMS released the final CY 2025 Medicare Physician Fee Schedule rule. The Endocrine Society has created a <a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2024/mpfs-2025-fr-summary.pdf" target="_blank">summary</a> for members to understand the rule as well as a table of the <a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2024/endo-cy-2025-mpfs-final-rule.xlsx" target="_self">final payment rates</a>.</p> <h4>New ICD-10 Diagnosis Codes for Obesity</h4> <p>Providers can bill under three new class codes: E66811 - Obesity, class 1; E66812 - Obesity, class 2; E66813 - Obesity, class 3, which are administered under the Center for Disease Control’s (CDC) National Center for Health Statistics (NCHS). These new codes will help endocrinologists be more specific when diagnosing obesity. The new codes also aim to remove the stigma that is often associated with people living with obesity. The Society has supported the creation of these codes, and we will continue to advocate for efforts to reduce weight stigma and bias.<a rel="noopener noreferrer" href="https://www.cdc.gov/nchs/icd/icd-10-cm/?CDC_AAref_Val=https://www.cdc.gov/nchs/icd/icd-10-cm.html" target="_blank"> Learn more. </a></p> <p><span style="font-size: 1.5rem; font-weight: 700;">CY 2025 Medicare Physician Fee Schedule Proposed Rule Summary</span></p> <p>On July 10, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) proposed rule for CY 2025 (CMS-1807-P). This rule updates payment policies and payment rates for Part B services furnished under the MPFS, as well as makes changes to the Quality Payment Program (QPP). Read our <a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/endocrine-society-mpfs-2025-summary.pdf">CY 2025 Medicare Physician Fee Schedule Proposed Rule Summary</a>, and view the <a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/endo-cy-2025-mpfs-proposed-rule.pdf">Payment Rates for Medicare Physician Services – Endocrine</a>.<span style="font-size: 1.25rem;"></span></p> <h4><strong>CMS Updates Conversion Factor for Physician Services</strong></h4> <p><span data-contrast="auto" class="TextRun SCXW110405892 BCX0" style="margin: 0px; padding: 0px; color: #000000;">Earlier this month, Congress adopted legislation that updated the </span><span data-contrast="none" class="TextRun Underlined SCXW110405892 BCX0" style="margin: 0px; padding: 0px; color: #467886;"><span class="NormalTextRun SCXW110405892 BCX0" data-ccp-charstyle="Hyperlink" style="margin: 0px; padding: 0px;"><a rel="noopener noreferrer" href="https://www.cms.gov/medicare/payment/fee-schedules/physician" target="_blank">Medicare Physician Fee Schedule</a></span></span><span data-contrast="auto" class="TextRun SCXW110405892 BCX0" style="margin: 0px; padding: 0px; color: #000000;"><span class="NormalTextRun SCXW110405892 BCX0" data-ccp-parastyle="No Spacing" style="margin: 0px; padding: 0px;"> (MPFS) conversion factor for claims processed from March 9 to December 31, 2024. The revised conversion factor has been updated to $33.29 reflecting a 1.68% </span><span class="NormalTextRun SCXW110405892 BCX0" data-ccp-parastyle="No Spacing" style="margin: 0px; padding: 0px;">increase </span><span class="NormalTextRun SCXW110405892 BCX0" data-ccp-parastyle="No Spacing" style="margin: 0px; padding: 0px;">from the </span><span class="NormalTextRun SCXW110405892 BCX0" data-ccp-parastyle="No Spacing" style="margin: 0px; padding: 0px;">previous</span><span class="NormalTextRun SCXW110405892 BCX0" data-ccp-parastyle="No Spacing" style="margin: 0px; padding: 0px;"> conversion factor. </span><span class="NormalTextRun SCXW110405892 BCX0" data-ccp-parastyle="No Spacing" style="margin: 0px; padding: 0px;">Since the conversion factor is not </span><span class="NormalTextRun SCXW110405892 BCX0" data-ccp-parastyle="No Spacing" style="margin: 0px; padding: 0px;">retroactive</span><span class="NormalTextRun SCXW110405892 BCX0" data-ccp-parastyle="No Spacing" style="margin: 0px; padding: 0px;">, CMS will not reprocess claims already </span><span class="NormalTextRun SCXW110405892 BCX0" data-ccp-parastyle="No Spacing" style="margin: 0px; padding: 0px;">submitted</span><span class="NormalTextRun SCXW110405892 BCX0" data-ccp-parastyle="No Spacing" style="margin: 0px; padding: 0px;">. View the <a href="/-/media/endocrine/files/advocacy/society-letters/2024/march/2024-final-physician-fee-schedule.pdf" target="_blank">updated MPFS payment rates</a> for the remainder of 2024.</span></span></p> <h4><strong>Congress Passes Legislation Averting Physician Payment Cuts</strong></h4> <p style="margin-left: 0in;">Last week, Congress passed legislation to provide some relief from the Medicare physician payment cuts that took effect earlier this year. On January 1, CMS instituted a 3.37% cut to all Medicare physician payments. The legislation passed by Congress will reduce this cut by about half (1.68%) which will provide some relief. The Endocrine Society continues to urge Congress to pass comprehensive physician payment reform legislation to provide physicians with adequate reimbursement. We have <a rel="noopener noreferrer" href="https://www.endocrine.org/-/media/endocrine/files/advocacy/society-letters/2023/march/phys-payment-ama.pdf" target="_blank">urged Congress</a> to pass legislation providing an inflation-based payment update based on the full Medicare Economic Index.</p> <h4><strong><span>CMS Assistance to Providers Affected by Cyberattack:</span></strong></h4> <p>The Centers for Medicare and Medicaid Services (CMS) announced that it will offer assistance to providers affected by the cyberattack on Change Healthcare. These payments are an advance to help providers and suppliers meet their obligations, but it is important to note that the payments are not a loan and cannot be forgiven. For more information, see our <a href="/-/media/endocrine/files/advocacy/society-letters/2024/march/cyber-attack-cms-assistance.pdf">summary</a>. CMS distributed <a href="/-/media/endocrine/files/advocacy/society-letters/2024/march/hhsletterandappendixtoproviders.pdf" target="_blank">additional resources</a> to provide guidance regarding connecting with payers, advanced payments, and payer resources.</p> <h4><strong><span>Integrating Complex Add-On Code G2211 Into Your Practice:</span></strong><span></span></h4> <p><span>The <span style="color: #333333;">Centers for Medicare and Medicaid Services (CMS) finalized the implementation of G2211, a complex add-on code that can be used by endocrinologists to pay for complex care services delivered by a provider with an ongoing relationship with the patient. The Endocrine Society created a <a rel="noopener noreferrer" href="https://www.endocrine.org/-/media/endocrine/files/advocacy/society-letters/2024/january/g2211-guidance.pdf" target="_blank">guidance document</a> on the code. The Endocrine Society also hosted a webinar to explain how endocrinologists can properly use this code and created an "<a href="/-/media/endocrine/files/advocacy/society-letters/2024/february/g2211-webinar-faq.pdf" target="_blank">FAQ</a>" sheet with answers to all questions asked; watch the <a rel="noopener noreferrer" href="https://ams.endocrine.org/eweb/DynamicPage.aspx?Site=ES&webCode=LoginRequired&IntendedURL=https://education.endocrine.org/sso.aspx?data=214:{token}" target="_blank">recording of the webinar</a>.</span></span></p> <h4><strong><span>January 17, 2024: Prior Authorization Process Final Rule: </span></strong></h4> <p><span>The Centers for Medicare and Medicaid Services (CMS) released a final rule that outlines policy changes to the prior authorization process for state and federal health plans. Read our <a rel="noopener noreferrer" href="https://www.endocrine.org/-/media/endocrine/files/advocacy/society-letters/2024/january/prior-auth-process.pdf" target="_blank">summary of the final rule</a>.</span></p> <h4><strong>November 2, 2023: CY 2024 Medicare Physician Fee Schedule Final Rule</strong></h4> <p>CMS released the final CY 2024 Medicare Physician Fee Schedule rule. The Endocrine Society <a href="https://www.endocrine.org/advocacy/society-letters/2023/mpfs-2024">commented</a> on the proposed rule which was released in July. Read our summary of the final rule <a href="/-/media/endocrine/files/advocacy/pdfs/mpfs-final-rule-summary-final.pdf" target="_blank">here</a>.</p> <h4 style="margin-bottom: 0in;">July 13, 2023: CY 2024 Medicare Physician Fee Schedule Rule</h4> <p>CMS released the CY 2024 Medicare Physician Fee Schedule proposed rule and factsheet. The Endocrine Society will be developing comments on the proposed rule, which are due September 11. <a href="/-/media/endocrine/files/advocacy/documents/2023/7202023-mpfs-pr-2024-brief-(002).pdf">Read our summary of the proposal.</a></p> <h4 style="margin-bottom: 0in;"><span>January 2023: Advancing Interoperability and Improving the Prior Authorization Process</span></h4> <p style="margin-bottom: 0in;"><span>The Centers for Medicare & Medicaid Services (CMS) released a proposed rule that outlines policy changes to the prior authorization (PA) process for several of the agency’s benefit programs. The rule will help alleviate burdensome procedures of prior authorization by streamlining the process for both patients and providers. <a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2023/prior-auth-proposed-rule-summary-es.pdf">Read the proposed rule summary</a>.</span></p> <p style="margin-bottom: 0in;"><span> </span></p> <p style="margin-bottom: 0in;"><span></span><strong style="font-size: 1.5rem;">November 1, 2022: CY 2023 Medicare Physician Fee Schedule Rule</strong></p> <p style="margin-bottom: 0in;">CMS released the CY 2023 Medicare Physician Schedule (MPFS) rule. <a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2023/pfs-final-rule-update-es-letter-head.pdf" target="_blank">Read our summary of the rule.</a></p> <p style="margin-bottom: 0in;"> </p> <p style="margin-bottom: 0in;"><a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2023/pfs-final-rule-update-es-letter-head.pdf" target="_blank"></a><strong style="font-size: 1.5rem;">July 7, 2022: CY 2023 Medicare Physician Fee Schedule Proposed Rule</strong></p> <p>CMS released the CY 2023 Medicare Physician Fee Schedule (MPFS) proposed rule and fact sheet. Read our <a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2023/endo-cy-2023-physician-fee-schedule-proposed-rule-summary.pdf" target="_blank">detailed summary</a> or <a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2023/pfs-one-pager-endo.pdf" target="_blank">one-pager</a> <span style="font-size: 1.25rem; font-weight: 400;">for more information.</span></p> <p style="margin-bottom: 0in;"><span style="font-size: 1.5rem; font-weight: 700;">December 15, 2021: Surprise Billing Requirements</span></p> <p>Beginning January 1, 2022, new requirements will go into effect for healthcare providers to protect patients from surprise bills. Read our <strong><a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/gfe-1pager-v2.pdf" target="_blank">fact sheet</a></strong> for more details. </p> <h4>October 6, 2021: <span>2022 Medicare Cuts Fact Sheet </span></h4> <p>Physicians are facing the “perfect storm,” which will bring almost a 10 percent cut in Medicare reimbursement on January 1, 2022. Congress must act to avert this cut because the administration does not have the authority to do so. <span><strong><a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2022-rules/endo-2022-physician-payment-fact-sheet.pdf">Learn more.</a></strong> </span></p> <h4>September 12, 2021: CEU Session Discussing Physician Payment.  </h4> <p>We delivered a briefing titled "Legislation & Regulations Affecting Endocrinologists: What You Need to Know About Medicare Physician Payment, Telehealth Expansion, and Drug Pricing." <a rel="noopener noreferrer" href="https://www.dropbox.com/sh/8hy7ztbi7ewqgqt/AACIrxT1W2emdEMKdQq6lU5ba?dl=0&preview=snR01_odjn49379_1low.mp4" target="_blank"><strong>Watch a recording.</strong></a></p> <h4>August 10, 2021: <span>CY 2022 Physician Fee Schedule Proposed Rule Summary</span></h4> <p><a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2022-rules/cy-2022-physician-fee-schedule-proposed-rule-endo-with-logo.pdf" target="_blank"><strong>Click here</strong></a> for a summary created by the Endocrine Society of the calendar year 2022 proposed Physician Fee Schedule.</p> <h4><span>April 1, 2021: <span data-contrast="auto" class="TextRun SCXW179150538 BCX0" style="margin: 0px; padding: 0px; color: #000000;">Endocrine Society </span><span data-contrast="auto" class="TextRun SCXW179150538 BCX0" style="margin: 0px; padding: 0px; color: #000000;">Physician Payment </span><span data-contrast="auto" class="TextRun SCXW179150538 BCX0" style="margin: 0px; padding: 0px; color: #000000;">Updat</span><span data-contrast="auto" class="TextRun SCXW179150538 BCX0" style="margin: 0px; padding: 0px; color: #000000;">es</span><span class="EOP SCXW179150538 BCX0" data-ccp-props="{'201341983':0,'335559739':160,'335559740':240}" style="margin: 0px; padding: 0px; color: #000000;"></span></span></h4> <p class="Paragraph SCXW85068405 BCX0" paraid="1011613806" paraeid="{3f34b705-ac9a-4470-9c82-44786ae51767}{215}" style="color: windowtext; background-color: transparent;"><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"><strong><em>Senate Reaches Deal to Avert Medicare Cuts</em></strong></span><span class="EOP SCXW85068405 BCX0" data-ccp-props="{'201341983':0,'335559739':160,'335559740':240}" style="margin: 0px; padding: 0px;"></span></p> <p class="Paragraph SCXW85068405 BCX0" paraid="71252753" paraeid="{3f34b705-ac9a-4470-9c82-44786ae51767}{221}" style="color: windowtext; background-color: transparent;"><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">As you may know, </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">a </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">two percent </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">reduction in Medicare payments to </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">providers </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">wa</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">s</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> scheduled to go into effect on April 1</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"><span class="NormalTextRun Superscript SCXW85068405 BCX0" data-fontsize="12" style="margin: 0px; padding: 0px;">st</span></span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">. </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">Last week</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">, the U.S. Senate </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">overwhelmingly passed </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">an agreement to </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">avert these cuts</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">. </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"></span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">The </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">legislation </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">w</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">ill</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> delay these reimbursement cuts through the end of 2021. </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">The House of Representatives is expected to </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">vote on the legislation the week of April 12.</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"></span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">I</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">n anticipation of this possible </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">Congressional action</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">, the Centers for Medicare and Medicaid Services (CMS) has </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. This will minimize the volume of claims the MACs must reprocess </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">when </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">Congress extends the suspension</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> of the Medicare cuts; </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">the MACs</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> also</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> will automatically reprocess any claims paid with the reduction applied</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">,</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> if necessary.</span><span class="EOP SCXW85068405 BCX0" data-ccp-props="{'201341983':0,'335559739':160,'335559740':257}" style="margin: 0px; padding: 0px;"></span></p> <p class="Paragraph SCXW85068405 BCX0" paraid="1727542700" paraeid="{f7b12ac3-7231-44b0-81a5-2c0988da20e5}{52}" style="color: windowtext; background-color: transparent;"><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"><strong><em>Society </em></strong></span><strong><em><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">Makes Important Change </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">to </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"></span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">E/M Requirement at CPT Panel</span></em></strong><span class="EOP SCXW85068405 BCX0" data-ccp-props="{'201341983':0,'335559739':160,'335559740':240}" style="margin: 0px; padding: 0px;"></span></p> <p class="Paragraph SCXW85068405 BCX0" paraid="536069224" paraeid="{f7b12ac3-7231-44b0-81a5-2c0988da20e5}{66}" style="color: windowtext; background-color: transparent;"><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">Earlier this month, </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">the American Medical Association’s CPT Panel </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">released </span><span data-contrast="none" class="TextRun Underlined SCXW85068405 BCX0" style="margin: 0px; padding: 0px; color: #0563c1;"><span class="NormalTextRun SCXW85068405 BCX0" data-ccp-charstyle="Hyperlink" style="margin: 0px; padding: 0px;"><a rel="noopener noreferrer" href="https://www.ama-assn.org/system/files/2020-12/cpt-corrections-errata-2021.pdf" target="_blank">technical corrections</a></span></span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> to </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">the outpatient E/M documents requirements</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">,</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> which included a change </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">to remove proposed limits on </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">how insulin would have been considered</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> when being monitored. </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">The Endocrine Society </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">advocated for </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">this change and worked with AACE to revise this language </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">at the February CPT meeting. The changes are retroactive to January 1</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"><span class="NormalTextRun Superscript SCXW85068405 BCX0" data-fontsize="12" style="margin: 0px; padding: 0px;">st</span></span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">, 2021.</span><span class="EOP SCXW85068405 BCX0" data-ccp-props="{'201341983':0,'335559739':160,'335559740':240}" style="margin: 0px; padding: 0px;"></span></p> <p class="Paragraph SCXW85068405 BCX0" paraid="1276699053" paraeid="{f7b12ac3-7231-44b0-81a5-2c0988da20e5}{109}" style="color: windowtext; background-color: transparent;"><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"><strong><em>FAQs on Coding and Billing for 99091 and 99457</em></strong></span><span class="EOP SCXW85068405 BCX0" data-ccp-props="{'201341983':0,'335559739':160,'335559740':240}" style="margin: 0px; padding: 0px;"></span></p> <p class="Paragraph SCXW85068405 BCX0" paraid="2052097656" paraeid="{f7b12ac3-7231-44b0-81a5-2c0988da20e5}{115}" style="color: windowtext; background-color: transparent;"><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">The Endocrine Society </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">has </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">work</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">ed </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"></span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">to help </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"></span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">our</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> members determine how to appropriately bill for the work delivered to patients with insulin pumps. </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"></span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">Recently, </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">we <a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2021-summary-and-final-rules/update-on-billing-medicare-for-treating-patients-with-insulin-pumps.pdf" target="_blank"><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">sent</span><span data-contrast="none" class="TextRun Underlined SCXW85068405 BCX0" style="margin: 0px; padding: 0px; color: #0563c1;"><span class="NormalTextRun SCXW85068405 BCX0" data-ccp-charstyle="Hyperlink" style="margin: 0px; padding: 0px;"></span></span></a> </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">information </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"></span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">with </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">clarification </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">by</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> CMS </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">on coding and billing for remote physiologic monitoring (RPM) codes 99091 and 99457</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> and</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> specifically how these codes </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"></span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">could be</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> used to reimburse for the care delivered to insulin pump patients</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">. We have</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> developed</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"> an FAQ document to help you </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">navigate these changes and answer an</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">y questions you may have about coding and billing for these codes</span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">. </span><span data-contrast="auto" class="TextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;"><span class="NormalTextRun SCXW85068405 BCX0" style="margin: 0px; padding: 0px;">You can view the FAQ </span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2 SCXW85068405 BCX0" style="margin: 0px; padding: 0px; border-bottom: 1px solid transparent;">document <a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2021-summary-and-final-rules/faqs-on-coding-and-billing-for-99091-and-99457.pdf" target="_blank">here</a>.</span></span><span class="EOP SCXW85068405 BCX0" data-ccp-props="{'201341983':0,'335559739':160,'335559740':240}" style="margin: 0px; padding: 0px;"></span></p> <div class="OutlineElement Ltr SCXW85068405 BCX0" style="color: #000000; margin: 0px; padding: 0px;"><span style="font-size: 1.5rem; font-weight: 700; color: #2c2a29;">Update: Billing Medicare for Treating Patients with Insulin Pumps</span></div> <p><span>The Endocrine Society has been working to help members determine how to appropriately bill for the work delivered to patients with insulin pumps. Since January 1, 2019, Medicare has been paid for remote physiologic monitoring (RPM) services since January 1, 2019, but there has been confusion regarding how these services may apply to care associated with insulin pumps. <a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2021-summary-and-final-rules/update-on-billing-medicare-for-treating-patients-with-insulin-pumps.pdf" target="_blank">Read our explanation here. </a></span></p> <h4>UPDATE: CMS Releases Physician Payment Final Rule for CY 2021</h4> <p style="margin-bottom: 8pt;">On December 1, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) final rule for CY 2021.  This rule updates payment policies and payment rates for Part B services furnished under the MPFS, as well as makes changes to the Quality Payment Program (QPP).  See below for summary and analysis of the rule:</p> <ul> <li style="margin-bottom: 8pt;"><a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2021-summary-and-final-rules/endocrine-society-em-webinar-1-11-21-v2.pdf" target="_blank">Updated Physician Payment Rule Webinar Slides </a></li> <li style="margin-bottom: 8pt;"><a href="/-/media/endocrine/files/advocacy/qpp-macra-documents/2021-summary-and-final-rules/em-1pager-updated.pdf" target="_blank">E/M Fact Sheet<span style="font-size: 15px;"></span></a></li> </ul> <hr> <p>The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula for Medicare reimbursement. For eligible clinicians, the Quality Payment Program (QPP) replaces previous Medicare Part B payment programs with the Merit-based Incentive Payment Program (MIPS) and Advanced Alternative Payment Models (Advanced APMs). Explore information and resources to learn how this affects your practice. Questions? Email us at <a href="/cdn-cgi/l/email-protection#badbdeccd5d9dbd9c3fadfd4ded5d9c8d3d4df94d5c8dd"><span class="__cf_email__" data-cfemail="c9a8adbfa6aaa8aab089aca7ada6aabba0a7ace7a6bbae">[email protected]</span></a>.</p> <p><strong>SPOTLIGHT: </strong><a rel="noopener noreferrer" href="https://qpp.cms.gov/about/resource-library" target="_blank">Quality Payment Program Resource Library</a></p> <h3>QPP/MACRA</h3> <h4>What is MACRA?</h4> <p>The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 is legislation that established a new payment system for doctors who treat Medicare patients, changing the way Medicare doctors are reimbursed. Under MACRA, the Sustainable Growth Rate (SGR) Formula was repealed, and providers are instead paid based on the quality and effectiveness of the care they provide. </p> <h4>What is the Quality Payment Program?</h4> <p>Quality Payment Program (QPP) is the name of the Medicare payment program set in place by MACRA. QPP allows Medicare providers to choose one of two payment tracks: Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (Advanced APMs).</p> <h4>How does this affect me or my practice?</h4> <p>You can find out whether you are part of the QPP by entering your provider number into the tool on this page: <a href="https://qpp.cms.gov/learn/eligibility">qpp.cms.gov/learn/eligibility</a>. Providers are part of the QPP if:</p> <ul> <li>You participate in an Advanced APM or </li> <li>You bill Medicare more than $90,000 in Part B allowed charges per year OR provide care for more than 200 Medicare patients per year </li> </ul> <p>There is additional <a href="https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf">technical support</a> available for practices in Small, Rural and Health Professional Shortage Areas (HPSAs). If you meet the eligibility requirements above, you must begin participation in the QPP on January 1 of the reporting year. Performance data for Year 1 must be submitted by March 31, 2018 in order to avoid a payment penalty.</p> <hr style="width:40%; margin:auto;"> <h3>MIPS</h3> <h4>Understanding the Measurement Criteria and Reporting Requirements</h4> <p>The Merit-based Incentive Payment System (MIPS) uses performance-based measures to determine Medicare payment adjustments. Medicare will use the four categories below to determine whether eligible physicians participating in MIPS will receive a positive, negative, or neutral payment adjustment to their Medicare payments. Click on the icons below to select and download the measurement CSV files for Quality, Advancing Care Information, and Improvement Activities. Fora full list of measures for each category, please see the links below. </p> <p><img style="width: 50px; height: auto; float: left;" alt="Quality" src="/-/media/endocrine/images/macra/performanceiconquality.png" srcset="/-/media/endocrine/images/macra/performanceiconquality.png?w=25&hash=8EA2359B68AF6A4BAEC967585430B873 1x, /-/media/endocrine/images/macra/performanceiconquality.png?w=50&hash=997606BF6C961D01E7A80D7FD3A81B35 2x"><a rel="noopener noreferrer" href="https://qpp.cms.gov/mips/explore-measures/quality-measures?py=2019#measures" target="_blank">Quality </a>(45%)<br> Replaces PQRS. Report at least six measures for the full calendar year.</p> <p><img style="width: 45px; height: auto; margin-right: 5px; float: left;" alt="Advancing Care Information" src="/-/media/endocrine/images/macra/performanceiconadvancingcareinformation.png" srcset="/-/media/endocrine/images/macra/performanceiconadvancingcareinformation.png?w=22&hash=36FF74C9036B97AB3B585357F59EEDCC 1x, /-/media/endocrine/images/macra/performanceiconadvancingcareinformation.png?w=45&hash=15AF9D490D8261EAA12E1CDEEDF75F8F 2x"><a rel="noopener noreferrer" href="https://qpp.cms.gov/mips/explore-measures/promoting-interoperability?py=2019#measures" target="_blank">Advancing Care Information</a> (25%)—Replaces Medicare EHR Incentive Program (Meaningful Use). Fulfill the required measures for a minimum of 90 days.</p> <p><img style="width: 50px; height: 37px; float: left;" alt="Improvement Activities" src="/-/media/endocrine/images/macra/performanceiconclinicalpracticeimprovementactivities.png" srcset="/-/media/endocrine/images/macra/performanceiconclinicalpracticeimprovementactivities.png?w=25&hash=8F8C1E64FCFAAE598C4D1B8F8939846A 1x, /-/media/endocrine/images/macra/performanceiconclinicalpracticeimprovementactivities.png?w=50&hash=2B990A9ADDF2A722F965618AE740706C 2x"><a rel="noopener noreferrer" href="https://qpp.cms.gov/mips/explore-measures/improvement-activities?py=2019#measures" target="_blank">Improvement Activities</a> (15%)mdash;110+ activities focused on care coordination, beneficiary engagement, and patient safety. Attest that you completed up to 4 Improvement Activities for a minimum of 90 days.</p> <p><img style="width: 50px; height: 37px; float: left;" alt="Cost" src="/-/media/endocrine/images/macra/performanceiconcost.png" srcset="/-/media/endocrine/images/macra/performanceiconcost.png?w=25&hash=7F2E89A174E85071CBDFD13982B54272 1x, /-/media/endocrine/images/macra/performanceiconcost.png?w=50&hash=D9557B4F94A4C09B8F39EE459D7BE644 2x"><a rel="noopener noreferrer" href="https://qpp.cms.gov/mips/explore-measures/cost?py=2019#measures" target="_blank">Cost</a> (15%)mdash;Replaces Value-Based Modifier. No data submission required. Calculated from adjudicated claims.</p> <hr style="width:40%; margin:auto;"> <h3>Advanced APMs</h3> <h4>Participating in Advanced APMs</h4> <p>You may be exempt from MIPS if you participate in an alternative payment model. Alternative Payment Models (APMs) are payment approaches that give incentives for high-quality and cost-efficient care. Advanced APMs are a type of APM that allow practices to take on some risk related to patient outcomes. To find Advanced APMs accepting enrollment, please visit <a rel="noopener noreferrer" href="https://innovation.cms.gov/" target="_blank">innovation.cms.gov</a>. </p> <p>In 2019, clinicians who participate in one of the Advanced APMs listed below will be exempt from the MIPS reporting requirements and will receive a 5% payment bonus from 2019 – 2024. If you leave an Advanced APM during 2018, make sure you have met the Advanced APM threshold or submit MIPS data to avoid a penalty.</p> <h4>Qualifying Advanced APMs</h4> <ul> <li><a rel="noopener noreferrer" href="https://innovation.cms.gov/initiatives/cjr" target="_blank">Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1- CEHRT)</a></li> <li><a rel="noopener noreferrer" href="https://innovation.cms.gov/initiatives/comprehensive-esrd-care/" target="_blank">Comprehensive ESRD Care (CEC) - Two-Sided Risk</a></li> <li><a rel="noopener noreferrer" href="https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus" target="_blank">Comprehensive Primary Care Plus (CPC+)</a></li> <li><a rel="noopener noreferrer" href="https://innovation.cms.gov/initiatives/Next-Generation-ACO-Model/" target="_blank">Next Generation ACO Model</a></li> <li><a rel="noopener noreferrer" href="https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html" target="_blank">Shared Savings Program - Track 2</a></li> <li><a rel="noopener noreferrer" href="https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html" target="_blank">Shared Savings Program - Track 3</a></li> <li><a rel="noopener noreferrer" href="https://innovation.cms.gov/initiatives/oncology-care/" target="_blank">Oncology Care Model (OCM) - Two-Sided Risk</a></li> </ul> <hr style="width:40%; margin:auto;"> <h3>Resources</h3> <h4>Endocrine Society Resources</h4> <ul> <li><a href="/-/media/endosociety/files/advocacy-and-outreach/important-documents/summary-of-qpp-for-endo-2020.pdf">2020 QPP Rule Summary</a></li> <li><a href="/-/media/endosociety/files/advocacy-and-outreach/important-documents/cy-2020-pfs-nprm---endo.pdf">2020 Physician Fee Schedule Rule Summary</a> </li> <li><a rel="noopener noreferrer" href="https://www.endocrine.org/external-login?ReturnURL=http%3A//education.endocrine.org/node/7001&userToken=%7Btoken%7D" target="_blank">Webinar: Evaluations and Management Coding Revision – What You Need to Know</a> | December 6, 2018</li> <li><a href="/-/media/endosociety/files/advocacy-and-outreach/other-documents/cy-2019-final-pfs-summary-endo.pdf">2019 Medicare Physician Fee Schedule Final Rule Summary</a> <ul> <li><a href="/-/media/endosociety/files/advocacy-and-outreach/other-documents/es---final-2019-mpfs-codes.xlsx">Final Medicare Physician Fee Schedule Codes </a></li> </ul> </li>  </ul> <h4>Centers for Medicare & Medicaid Services</h4> <ul> <li><a rel="noopener noreferrer" href="https://www.medicare.gov/physiciancompare/" target="_blank">2017 QPP Performance Information - Physician Compare </a><a href="https://www.medicare.gov/physiciancompare/" target="_blank"></a></li> <li><a rel="noopener noreferrer" href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJlbWFpbCI6InNrdXRsZXJAZW5kb2NyaW5lLm9yZyIsImJ1bGxldGluX2xpbmtfaWQiOiIxMTIiLCJzdWJzY3JpYmVyX2lkIjoiMjI4NDM3NTQ4IiwibGlua19pZCI6IjU5MDA2NTc2NyIsInVyaSI6ImJwMjpkaWdlc3QiLCJ1cmwiOiJodHRwczovL3FwcC1jbS1wcm9kLWNvbnRlbnQuczMuYW1hem9uYXdzLmNvbS91cGxvYWRzLzU1OC8yMDE5JTIwTUlQUyUyMFF1YWxpdHklMjBVc2VyJTIwR3VpZGUucGRmIiwiYnVsbGV0aW5faWQiOiIyMDE5MDYxMC42ODI2OTMxIn0.1CNTymrudPRncA_9sEDGq1L36LsS4WdQJdf0nx67CeY" target="_blank">2019 MIPS Quality User Guide </a><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJlbWFpbCI6InNrdXRsZXJAZW5kb2NyaW5lLm9yZyIsImJ1bGxldGluX2xpbmtfaWQiOiIxMTIiLCJzdWJzY3JpYmVyX2lkIjoiMjI4NDM3NTQ4IiwibGlua19pZCI6IjU5MDA2NTc2NyIsInVyaSI6ImJwMjpkaWdlc3QiLCJ1cmwiOiJodHRwczovL3FwcC1jbS1wcm9kLWNvbnRlbnQuczMuYW1hem9uYXdzLmNvbS91cGxvYWRzLzU1OC8yMDE5JTIwTUlQUyUyMFF1YWxpdHklMjBVc2VyJTIwR3VpZGUucGRmIiwiYnVsbGV0aW5faWQiOiIyMDE5MDYxMC42ODI2OTMxIn0.1CNTymrudPRncA_9sEDGq1L36LsS4WdQJdf0nx67CeY" target="_blank"></a></li> <li><a rel="noopener noreferrer" href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJlbWFpbCI6InNrdXRsZXJAZW5kb2NyaW5lLm9yZyIsImJ1bGxldGluX2xpbmtfaWQiOiIxMTMiLCJzdWJzY3JpYmVyX2lkIjoiMjI4NDM3NTQ4IiwibGlua19pZCI6IjU5MDA2NTc3MSIsInVyaSI6ImJwMjpkaWdlc3QiLCJ1cmwiOiJodHRwczovL3FwcC1jbS1wcm9kLWNvbnRlbnQuczMuYW1hem9uYXdzLmNvbS91cGxvYWRzLzU1OS8yMDE5JTIwTUlQUyUyMENvc3QlMjBVc2VyJTIwR3VpZGUucGRmIiwiYnVsbGV0aW5faWQiOiIyMDE5MDYxMC42ODI2OTMxIn0.ZOvsWd_E4Bbxto2ZIdlf4sZViVVGVszW3XLFGKCQOJU" target="_blank">2019 MIPS Cost User Guide </a></li> <li><a rel="noopener noreferrer" href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJlbWFpbCI6InNrdXRsZXJAZW5kb2NyaW5lLm9yZyIsImJ1bGxldGluX2xpbmtfaWQiOiIxMDIiLCJzdWJzY3JpYmVyX2lkIjoiMjI4NDM3NTQ4IiwibGlua19pZCI6IjU5MDA2NTczMSIsInVyaSI6ImJwMjpkaWdlc3QiLCJ1cmwiOiJodHRwczovL3FwcC1jbS1wcm9kLWNvbnRlbnQuczMuYW1hem9uYXdzLmNvbS91cGxvYWRzLzU1Ny8yMDE5JTIwTUlQUyUyMEVsaWdpYmlsaXR5JTIwRGVjaXNpb24lMjBUcmVlLnBkZiIsImJ1bGxldGluX2lkIjoiMjAxOTA2MTAuNjgyNjkzMSJ9.KL4r-oeIVenyVd2CeefsuMSgTdSW2QRbrw3GReLPbfg" target="_blank">2019 MIPS Eligibility Decision Tree</a></li> <li><a rel="noopener noreferrer" href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJlbWFpbCI6InNrdXRsZXJAZW5kb2NyaW5lLm9yZyIsImJ1bGxldGluX2xpbmtfaWQiOiIxMDEiLCJzdWJzY3JpYmVyX2lkIjoiMjI4NDM3NTQ4IiwibGlua19pZCI6IjU5MDA2NTcyNyIsInVyaSI6ImJwMjpkaWdlc3QiLCJ1cmwiOiJodHRwczovL3FwcC1jbS1wcm9kLWNvbnRlbnQuczMuYW1hem9uYXdzLmNvbS91cGxvYWRzLzUxNi9QYXJ0aWNpcGF0aW5nJTIwaW4lMjBRUFAlMjBpbiUyMDIwMTklMjBJbmZvZ3JhcGhpYy5wZGYiLCJidWxsZXRpbl9pZCI6IjIwMTkwNjEwLjY4MjY5MzEifQ.iFWU9q8AXaf_GslZR83Guen8EtbVICNJLAkmkuxppec" target="_blank">Participating in QPP in 2019 Infographic</a> <a href="https://qpp.cms.gov/about/resource-library" target="_blank"></a></li> <li><a rel="noopener noreferrer" href="https://qpp.cms.gov/about/resource-library" target="_blank">Quality Payment Program Resource Library</a></li> </ul> <p><a href="https://qpp.cms.gov">Quality Payment Program</a>—A regularly updated resource to help eligible providers understand QPP components. Includes:</p> <ul> <li><a href="https://qpp.cms.gov/learn/apms">Advanced APMs</a></li> <li><a href="https://qpp.cms.gov/resources/education">Additional Resources and Education</a></li> </ul> <p><a href="https://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/">Transforming Clinical Practice Initiative</a>—The initiative is one part of a strategy advanced by the Affordable Care Act to strengthen the quality of patient care and spend health care dollars more wisely.</p> <p><a href="https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf">Support for Small Practices</a>—List of QPP technical assistance by region for practices with 15 or fewer clinicians.</p> <h4>American Medical Association</h4> <p><a href="https://www.ama-assn.org/practice-management/mips-action-plan">MIPS Action Plan</a>—A resource for physicians not yet participating in the new Medicare payment program is designed to help practices prepare for, and operate under, the regulation.</p> <p><a href="https://www.stepsforward.org/modules/value-based-care">Preparing Your Practice for Value-based Care</a>—This module will help the user transition to a value-based care model.</p> <p><a href="https://reachmd.com/programs/inside-medicares-new-payment-system/">Inside Medicare's New Payment System (Podcast Series)</a>—Podcasts presented by ReachMD that cover various topics related to QPP, such as MACRA for small practices and how to use an EHR to participate in MACRA</p> <h4>American College of Physicians</h4> <p><a href="https://www.acponline.org/practice-resources/business-resources/payment/medicare/macra">MACRA and the Quality Payment Program resource center</a></p> <hr style="width: 40%; margin: auto;">  <h3>Glossary</h3> <p><strong>MACRA</strong>—Medicare Access and CHIP Reauthorization Act of 2015 is landmark legislation that changes how Medicare pays physicians.</p> <p><strong>QPP</strong>—Quality Payment Program is the new Medicare Part B payment program focused on care quality.</p> <p><strong>MIPS</strong>—Merit-based Incentive Payment System is the payment system for eligible clinicians who are not participating in an Advanced APM. The payments in MIPS are based on four categories: Quality, Improvement Activities, Advancing Care Information, and Cost.</p> <p><strong>APM</strong>—An Advanced Payment Model is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care.</p> <p><strong>Advanced APM</strong>—Advanced Alternative Payment Models are a subset of APMs that let practices earn more for taking on some risk related to their patients' outcomes.</p> <p><strong>CMS</strong>—Centers for Medicare & Medicaid Services is a US federal agency under the Department of Health and Human Services which administers Medicare, Medicaid, and the State Children's Health Insurance Program.</p> <p><strong>HHS</strong>—United States Department of Health and Human Services</p> <div class="end-more-text js-more-text"> </div> </div> <div class="end-page-meta"> <div class="end-page-meta__time"> <span class="end-page-meta__time-label">Last Updated: </span> <time class="end-page-meta__date" datetime="2024-11-14">November 14, 2024</time> </div> </div> </div> </div> <div class="container__col"> <div class="container__inner"> <nav class="end-lp-secondary-nav js-secondary-nav" style=transform:translateY(52px);margin-bottom:52px; aria-label="Site Sub navigation"> <a href="" class="end-lp-secondary-nav__toggle js-nav-toggle"> <span></span> More in this section </a> <a href="/improving-practice"> <h6 class="end-lp-secondary-nav__title js-menu-title">IMPROVING PRACTICE</h6> </a> <ul class="end-lp-secondary-nav__menu js-menu"> <li class="end-lp-secondary-nav__item "> <div class="end-lp-secondary-nav__category no-icon"> <a href="/improving-practice/clinical-practice-guidelines" id="8091370a-2b38-4b40-9370-4a330542960b" >Clinical Practice Guidelines</a> </div> </li> <li class="end-lp-secondary-nav__item "> <div class="end-lp-secondary-nav__category no-icon"> <a href="/improving-practice/education-and-training" id="4721d434-3749-4627-849f-dd4fa2fa2328" >Education and Training</a> </div> </li> <li class="end-lp-secondary-nav__item "> <div class="end-lp-secondary-nav__category no-icon"> <a href="/improving-practice/hypoglycemia-prevention-initiative" id="0395f1b9-53fc-48f0-856d-2e2f3bc0489d" >Hypoglycemia Prevention Initiative</a> </div> </li> <li class="end-lp-secondary-nav__item is-active is-current-parent"> <div class="end-lp-secondary-nav__category no-icon"> <a>Physician Payment: QPP and MACRA </a> </div> <ul class="end-lp-secondary-nav__submenu"> <li class="end-lp-secondary-nav__subitem "> <a href="/improving-practice/macra/app" id="db3d8bff-e0fc-4260-a758-0da4eeb22b0a" >Quality Payment Program Reporting</a> </li> </ul> </li> <li class="end-lp-secondary-nav__item "> <div class="end-lp-secondary-nav__category no-icon"> <a href="/improving-practice/transitions" id="686cbe60-f85c-4920-a984-114f22d240c2" >Transitions of Care</a> </div> </li> </ul> </nav> <section class="end-promo "> <header class="end-promo__top-header">  <div class="end-promo__eyebrow">Membership</div> <a href="/membership/join" > <h2 class="end-promo__title"> Become a Member</h2> </a> </header> <figure class="end-promo__media"> <a href="/membership/join" > <picture> <source srcset="/-/media/endocrine/images/membership/2021-pages-refresh/_1796x943_promo_membership_recruitment5.jpg?w=380&hash=16A924153EFD9A3F95F88F070DB4EAAD 1x, /-/media/endocrine/images/membership/2021-pages-refresh/_1796x943_promo_membership_recruitment5.jpg?w=760&hash=82F3BF45110A4894AC8CA119F1D249C0 2x" media="(min-width: 56.9375em)"> <source srcset="/-/media/endocrine/images/membership/2021-pages-refresh/_1796x943_promo_membership_recruitment5.jpg?w=260&hash=AC4D6A08D82E6912C57C8C209594DFDC 1x, /-/media/endocrine/images/membership/2021-pages-refresh/_1796x943_promo_membership_recruitment5.jpg?w=520&hash=CF081129F67112DEF0ED4FED54BE60B7 2x" media="(min-width: 29.4375em)"> <source srcset="/-/media/endocrine/images/membership/2021-pages-refresh/_1796x943_promo_membership_recruitment5.jpg?w=470&hash=4E2D37B58DB3834BFF13C6013D1CE7C7 1x, /-/media/endocrine/images/membership/2021-pages-refresh/_1796x943_promo_membership_recruitment5.jpg?w=940&hash=2F91C4624CDDACFF57D5E37813FF0AB4 2x" media="(min-width: 29.375em)"> <img src="/-/media/endocrine/images/membership/2021-pages-refresh/_1796x943_promo_membership_recruitment5.jpg?la=en&h=200&mw=380&w=380&hash=E66892B4FEF33AB17443DA50BF42D99D" alt="" /> </picture> </a> <figcaption class="u-visuallyhidden">Join our endocrine community and become a member! 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