CQR Programs
Quality Payment Program
The Quality Payment Program (QPP) was authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which ended the Sustainable Growth Rate formula that would have resulted in a significant cut to payment rates for clinicians participating in Medicare. MACRA advances a forward-looking, coordinated framework for clinicians to participate in the Quality Payment Program, which rewards value in 1 of 2 ways:
Visit QPP - Merit-based Incentive Payment System (MIPS): Clinicians who participate in MIPS are subject to a performance-based payment adjustment on charges under the Physician Fee Schedule.
- Advanced Alternative Payment Models (APMs): Clinicians who participate in an Advanced APM and achieve certain thresholds may be eligible for higher payment rates under the Physician Fee Schedule.
CMS Electronic Prescribing for Controlled Substances
The CMS EPCS Program helps address the opioid crisis by requiring that prescribers issuing Schedule II-V controlled substance prescriptions covered under Medicare Part D prescription drug plans transmit those prescriptions electronically to the pharmacy. All prescribers of controlled substances covered under Part D are included in the program regardless of their Medicare participation status. The first measurement year for the program began on January 1, 2023.
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