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February 2019
Health e Paradigm Assists Members in MIPS Participation
Health e Paradigm wants to help Medical Association of Georgia members have the best opportunity to earn positive incentives under the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP) and the Merit-Based Incentive Payment System (MIPS) requirements. 

In 2019 all MIPS participants will be required to use certified health technology for data sharing. Meeting Promoting Interoperability measures may be simplified for organizations utilizing Health e Paradigm because the secure electronic exchange of health information is the core of the Health e Paradigm professional tools and services.

As part of Health e Paradigm’s continued commitment to working with physicians to thrive in MIPS participation, Health e Paradigm can assist with assessing provider eligibility status, identifying and reviewing quality measures, identifying Clinical Improvement Activities, reviewing Promoting Interoperability scores, and determining measure submission method. Ryan Larosa, Director of Health e Paradigm, can come to your facility and help you get started. Call Ryan at 678.303.9290.
Highlights of the 2019 MIPS Program*:

  • Performance category percentages have changed slightly, and for 2019 will be Quality: 45%; Cost: 15%; Improvement Activities: 15%; and Promoting Interoperability: 25%.
  • An additional $500 million for exceptional performance is available to eligible clinicians whose final score meets or exceeds the additional performance threshold of 75 points.
  • The maximum negative payment adjustment is -7% (the maximum positive payment adjustment generally can be up to 7%) for 2019 performance year.
  • The small practice bonus will increase to 6 points, and move to the Quality performance category.
  • CMS implemented a performance threshold of 30 points.
  • A combination of collection types will be allowed for the Quality performance category.
  • Data completeness requirements are the same as Year 2 (60% of clinician's or group's patients across all payers for the performance period).
  • Opportunities to participate are expanding to new eligible provider types, including physical therapists, occupational therapists, qualified speech-language pathologists, qualified audiologists, clinical psychologists, and registered dietitians or nutrition professionals. 
  • An opt-in policy is added to allow some, who otherwise would have been excluded under the low-volume threshold, the option to participate in MIPS. Clinicians can opt-in if they meet or exceed at least one, but not all three, of the low-volume threshold criteria.

For more information and assistance, contact Ryan Larosa, Director of Health e Paradigm at rlarosa@mag.org .

*Article sources : Review the complete  PFS Final Rule and the Year 3 Quality Payment Program policies, by accessing the following resources:

  • Executive Summary - provides a high-level summary of the Quality Payment Program Year 3 final rule policies.
  • Fact Sheet - offers an overview of the policies for Year 3 (2019) and compares these policies to the current Year 2 (2018) requirements.
One Stop Shop for Electronic Clinical Quality Resources
The Centers for Medicare & Medicaid Services (CMS) recently updated the  Electronic Clinical Quality Improvement (eCQI) Resource Center website based on user feedback. It is the one-stop shop for the most current resources to support electronic clinical quality improvement. The website serves as a centralized location for federal eCQI initiatives and includes the most current Electronic Clinical Quality Measure (eCQM) specifications, as well as links to the tools, standards, education, and materials critical to support development, testing, implementation, and reporting of eCQMs. The eCQI Resource Center offers two new resources based on stakeholder feedback.

The new eCQM Tools, Resources, & Collaboration (infoTRAC) previously named eCQM Tools & Resources, has been revised based on user input. This interactive graphic provides an in-depth overview of the tools, standards, and resources used in the various stages of the eCQM lifecycle. Stakeholders will find references and links to tools and resources specific to their areas of interest.

Visit the eCQI Resource Center to learn more.

For More Information
Submit specific questions regarding eCQMs, eCQM standards, and eCQM tools to the  eCQI Resource Center . The most updated measure specifications and supplemental materials can be found at the  eCQI Resource Center .
Find the New Shared Savings Program and Quality Payment Program Interactions Guide Online
The Quality Payment Program Resource Library has a new interactions guide available to help clinicians understand participation tracks in 2019. The Medicare Shared Savings Program and Quality Payment Program (QPP) Interactions Guide provides:

  • An overview of 2019 Shared Savings Program participation tracks and whether they meet the criteria of a Merit-based Incentive Payment System (MIPS) Alternative Payment Model (APM) or Advanced APM; 
  • An explanation of the APM scoring standard and eligibility for eligible clinicians (ECs) participating in a Shared Savings Program Accountable Care Organization (ACO); 
  • Details on how ECs participating in an ACO are scored under MIPS if their Shared Savings Program participation agreement is terminated during the performance year; and 
  • A description of how CMS identifies Qualifying APM Participants for ECs participating in an ACO meeting the Advanced APM criteria. 

CMS encourages Shared Savings Program ACOs and their participants to review the guide.
MIPS Eligible Clinicians Can Start Submitting Data for 2018
The Centers for Medicare & Medicaid Services (CMS) has officially opened the data submission period for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in Year 2 (2018) of the Quality Payment Program (QPP). With the exceptions noted in the paragraph below, data can be submitted and updated any time through April 2, 2019.

CMS Web Interface users need to report their Quality performance category data between January 22 and March 22, 2019. Also, for clinicians who reported Quality measures via Medicare Part B claims throughout the 2018 performance year , CMS will receive quality data from claims processed by the Medicare Administrative Contractor, and claims for services furnished during 2018 must be processed within 60 days after the end of the 2018 performance period.

How to Submit 2018 MIPS Data
Clinicians will follow the steps outlined below to submit their data:

  1. Go to the Quality Payment Program website
  2. Log-in using your QPP access credentials (see below for directions)
  3. Submit your MIPS data for Year 2 (2018)

How to Login to the Quality Payment Program Data Submission System
To submit data, clinicians will need to use the new HCQIS Authorization Roles and Profile (HARP) system. Previously, clinicians received their credentials through the Enterprise Identity Management (EIDM) system. Clinicians are encouraged to log in early to familiarize themselves with the system.

  • Previous EIDM Accounts: For all clinicians who previously had an EIDM account, you were automatically transitioned to HARP, and will use your existing EIDM user ID and password to sign in to the QPP website. 
  • New Clinicians: For all clinicians who didn’t have an EIDM account, you’ll need to enroll with HARP. For a step-by-step guide to signing up for a HARP account, refer to the QPP Access User Guide.

Note: Clinicians who are not sure if they are eligible to participate in the Quality Payment Program can check their eligibility status using the  QPP Participation Status Tool .

For More Information
To learn more about how to submit data, please review the  2018 MIPS Data Submission FAQs and other resources available in the QPP Resource Library .

If you have questions about how to submit 2018 MIPS data, contact: the Quality Payment Program by email:  QPP@cms.hhs.gov ; or by phone: 1-866-288-8292/TTY: 1-877-715-6222.

If you would like to learn how Health e Paradigm can submit your 2019 data for you through the Doctors Quality Reporting Network, please call, 877.921.7196.
Come and See Us!
March 20, 2019
North Fulton Medical Group Management Association
March Event
The Metropolitan Club
Alpharetta, GA



Ryan Larosa
Director, Health e Paradigm
678.303.9290