Quality Payment Program (QPP)
PRACTICING NEUROLOGISTs & ADMINISTRATORs
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the Sustainable Growth Rate. It enabled the Centers for Medicare & Medicaid Services (CMS) to create a new program that transforms how providers are paid under Medicare.
In June 2016, CMS released the proposed rule related to MACRA, which established the Quality Payment Program (QPP). The QPP is made up of three components; Merit-based Incentive Payment System (MIPS), MIPS Value Pathways (MVPs), and Alternative Payment Models (APMs).
Read the AAN's summary of the 2025 Medicare Physician Fee Schedule proposed rule.
Read the AAN's summary of the 2024 Medicare Physician Fee Schedule final rule.
Read the AAN's summary of the 2023 Medicare Physician Fee Schedule final rule.
Merit-based Incentive Payment System (MIPS)
The Merit-based Incentive Payment System (MIPS) is a new approach to paying for Medicare Part B items and services in which clinicians may receive an increase or decrease in their payments based on their performance.
MIPS is made up of four categories: Quality, Improvement Activities, Promoting Interoperability, and Cost. Your performance in 2024 in these four categories will generate a score that will determine payment adjustments in 2026. To avoid a penalty in 2024, you must score 75 points across all four categories (see image below).
MIPS Value Pathways (MVPs)
Clinicians have the option to report via the MIPS Value Pathway (MVPs) framework which is a transition from traditional MIPS. MVPs include a subset of measures and activities tied to a specific specialty, clinical condition, and episode of care. Providers have access to 16 MVPs in 2024, three of which are neurology specific:
Alternative Payment Models (APMs)
Alternative Payment Models (APMs) are payment approaches that incentivize high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. Bundled payments, Accountable Care Organizations (ACOs), Patient-Centered Medical Homes (PCMHs), and episodes of care are all examples of APMs. Learn more about other value-based care models.
Advanced Alternative Payment Models are a subset of APMs recognized by the Quality Payment Program. Qualified participants in Advanced APMs may earn a 5-percent incentive payment and be exempt from MIPS if enough of their patients are included in the APM. Learn more about which models are Advanced APMs at qpp.cms.gov. The APM Performance Pathway (APP) is required for individuals, groups, and APM entities participating in the Medicare Shared Savings Program (MSSP) and available for other MIPS APM participants.
Quality Payment Program (QPP) COVID-19 Relief
The Centers for Medicare & Medicaid Services (CMS) has extended flexibilities related to COVID-19. Check out the QPP website for the latest updates.
| Who is eligible? | Who is excluded? |
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Eligible clinicians include physicians, NPs, PAs, clinical nurse specialists, and certified registered nurse anesthetists who exceed the low-volume threshold. Check your MIPS participation status online. Just enter your National Provider Identifier (NPI) to determine whether you're required to participate. Eligibility data is now available at the group and individual level, which will allow you to make strategic participation decisions. |
Clinicians who are qualified participants in Advanced APMs, are new to Medicare Part B, or meet the low-volume threshold are not required to participate. Clinicians who see 200 or fewer Medicare Part B patients, have less than $90,000 Medicare Part B charges per year or provide 200 or fewer covered professional services do not meet the low-volume threshold and will be exempt from MIPS participation. These clinicians have the opportunity to voluntarily report or opt-in for MIPS reporting. Learn more about your reporting options. |
| Category | Resource |
| General | Find all QPP Resources for 2024 and past years in the QPP Resource Library |
| General | Not sure where to start? CMS has made free technical assistance available to practices of all sizes. Find your provider. |
| Small/Solo Practices | Explore QPP assistance offerings for small and solo practitioners reporting MIPS |
| Small/Solo Practices | Understand what's new in 2024 for small practices (15 or fewer clinicians) |
| Merit-based Incentive Payment System (MIPS) | Unsure of your eligibility status in 2024? Click here to help determine your status. |
| Quality | Learn how to Navigate the 2024 Quality Component of MIPS |
| Quality | Explore which 2024 Quality Measure are best for you and your practice. |
| Quality | Review the 2024 quality benchmarks for reporting. |
| Cost | Learn about the 2024 Cost Measures within QPP |
| Improvement Activities | Review the AAN Tip Sheet: Improvement Activities for Neurologists to Consider |
| Promoting Interoperability | Check out AAN's Practice Top 5 on Promoting Interoperability |
| MIPS Value Pathways (MVPs) | Learn more about the MVP track defined measures and activities related to a specialty or condition, including stroke. |
| MVPs | Explore the CMS 2024 MVPs Implementation Guide |
| MVPs | Understand new MIPS Value Pathways |
| MVPs | Explore the Episodic Neurological Conditions MVP and decide if you should report |
| MVPs | Explore the Neurodegenerative Conditions MVP and decide if you should report |
| MVPs | Explore the Stroke MVP and decide if you should report |
| Alternative Payment Models (APMs) | Explore different types of APMs in the QPP: Advanced APMs, MIPS APMs, and All-Payer APMs |
| APMs | Learn about specific Alternative Payment Models and how to apply. |
| APMs | Learn how to connect with your APM entity |
| APM Performance Pathway (APP) | Learn about the APP track required for Medicare Shared Savings Program participants and optional for other MIPS APM clinicians |
Questions?
Questions about QPP or another care model? Contact us for more information.