What you need to know about Medicare’s physician Quality Payment Program

MACRA Coverage

  Quality Payment Program Timeline

January 1, 2017-December 31, 2017 | Performance period for 2019 payment (can report data for any 90-day period this year)

March 31, 2017 | First APM snapshot; (also June 30 and Aug. 31)

April 1–June 30, 2017 | Registration period for submitting data via the CMS web interface and/or administering the Consumer Assessment of Healthcare Providers and Systems survey for MIPS

Oct. 2, 2017 | Start of final 90-day reporting period that counts for MIPS payment adjustments in 2019

Jan. 1–March 31, 2018 | Submission period for 2017 performance data for MIPS

Jan. 1–Dec. 31, 2018 | Performance period for 2020 payment (full-year reporting for quality and cost, 90-day reporting for advancing care information and improvement activities)

Midyear 2018 | Performance feedback for 2017 performance period released

Oct. 2, 2018 | Start of final 90-day reporting period for improvement activities and advancing care information

2019 | MIPS payment adjustment +/- 4%

2019-2024 | APMs 5% annual bonus payments

Jan. 1–Dec. 31, 2019 | Performance period for 2021 payment

2020 | MIPS payment adjustment +/- 5%

2021 | MIPS payment adjustment +/- 7%

2022 and after | MIPS payment adjustment +/- 9%

2019-2024 | APMs 5% annual bonus payments

  Glossary of Terms

Advanced APM

An Advanced Alternative Payment Model, one of the two tracks in the Quality Payment Program, is a specific type of Medicare payment model focused on quality and value. APM participants can earn Medicare incentive payments for being part of innovative payment models. Advanced APMs require participants to use certified EHR technology, be paid based on quality measures similar to those of MIPS and take on significant financial risk.

Advancing care information

A performance category in the MIPS track akin to meaningful use that requires physicians to use certified EHR technology.


Certified electronic health record technology meets standards set out by the Office of the National Coordinator for Health Information Technology and CMS. For an EHR to be used in the Medicare and Medicaid EHR Incentive Programs, it must meet these standards.

Clinical practice improvement

A performance category in the MIPS track that requires physicians to use care coordination, beneficiary engagement, patient safety and other activities that will improve outcomes.

Low-volume threshold

A provider whose volume is under the threshold is not subject to MIPS payment adjustments. The threshold is, during the performance period, Medicare Part B charges of $30,000 or the provision of care to 100 or fewer Medicare Part B beneficiaries.


The Medicare Access and CHIP Reauthorization Act replaced the sustainable-growth rate and changed how Medicare reimburses physicians.


The Merit-based Incentive Payment System, one of the two tracks in the Quality Payment Program, repackages parts of the Physician Quality Reporting System, the value modifier and the Medicare electronic health record incentive program. The MIPS score is based on four measures: quality, cost, advancing care information and clinical practice improvement activities.

Pick your pace

Allows providers to avoid 2019 QPP penalties by choosing one of four options for submitting 2017 data on MIPS measures: submit some data, submit data for a 90-day period, submit data for the full year or participate in an APM.

Quality Payment Program

MACRA’s reimbursement system includes two tracks, APMs and MIPS.

MACRA Resources