The Centers for Medicare & Medicaid Services (CMS) updated its Quality Payment Program Participation Status Tool based on calculations from the third snapshot of data from Alternative Payment Model (APM) entities. The third snapshot includes data from Medicare Part B claims with dates of service between January 1 and August 31, 2018. As a reminder, the tool includes 2018 Qualifying APM Participant (QP) and MIPS APM status.

For those in the Medicare Shared Savings Program, a fourth snapshot date, December 31, will apply to you. It’s used for determining which eligible clinicians are participating in a MIPS APM for purposes of the APM scoring standard.

Note: If you are in participating in a MIPS APM (and do not qualify as a QP or Partial QP), you will most likely need to participate in MIPS, but will be subject to the APM Scoring Standard.

To learn more about how CMS determines QP and MIPS APM status for each snapshot, please view the QP Methodology Fact Sheet.

What Does QP Status and MIPS APM Status Mean?

If you qualify as a QP, this means you are:

• Eligible for the 5% APM incentive bonus, and
• Exempt from participating in MIPS.

How Do I Check My QP or MIPS APM Status?

To view your QP or MIPS APM status at the individual level:

• Go to: https://qpp.cms.gov/participation-lookup
• Enter your 10-digit National Provider Identifier (NPI)

To check your group’s 2018 eligibility at the APM entity level:

• Log into the CMS Quality Payment Program website.  Learn how by downloading the QPP Access User Guide.
• Browse to the Taxpayer Identification Number affiliated with your group
• Access the details screen to view the eligibility status of every clinician based on their NPI

What APMs are Included in the QPP Participation Status Tool?

The updated Quality Payment Program Participation Status Tool includes the following 2018 Advanced APMs and MIPS APMs:

• Bundled Payments for Care Improvement Advanced Model (BPCI Advanced)
• Comprehensive ESRD Care (CEC) Model (LDO arrangement)
• Comprehensive ESRD Care (CEC) Model (non-LDO two-sided risk arrangement)
• Comprehensive ESRD Care (CEC) Model (non-LDO one-sided risk arrangement)
• Comprehensive Primary Care Plus (CPC+) Model
• Medicare Accountable Care Organization (ACO) Track 1+ Model
• Medicare Shared Savings Program Accountable Care Organizations – Track 1, 2, 3
• Next Generation ACO Model
• Oncology Care Model (OCM) (one-sided Risk Arrangement)
• Oncology Care Model (OCM) (two-sided Risk Arrangement)
• Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model)

For a comprehensive list of APMs, visit the QPP Resource Library.

Questions?

Contact the Quality Payment Program Service Center by:

• Phone: 1-866-288-8292 (TTY: 1-877-715-6222)
• Email: QPP@CMS.HHS.GOV

Website: CMS.GOV