Medicare Quality Payment Program for 2021

March 2021

2021 implementation plans for the Quality Payment Program

Medicare Quality Payment Program Cvr

This year marks the fifth year of the Centers for Medicare and Medicaid Services’ (CMS’) implementation of the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA ushered in a new Medicare payment system, the Quality Payment Program (QPP), which was intended to promote high-value care that yielded lower costs and improved patient outcomes. Consisting of two parts – the Merit-Based Incentive Payment System and Advanced Alternative Payment Models – the QPP has evolved since the program began in 2017, with CMS releasing updated program rules each fall. The following information provides some highlights of the rules CMS announced for 2021.

COVID-19 Impact on the QPP

The COVID-19 public health emergency had a significant impact on the QPP program in 2020, including disruption of reporting deadlines for the 2019 program year. CMS made accommodations and adjustments to the program to help reduce the reporting burden on physician practices, and minimize the impact of potential negative payment adjustments in future years. Notably, they made broad use of the “extreme and uncontrollable circumstances” exceptions policy, which allows MIPS participants to be held harmless from negative payment adjustments. Accommodations were made for the 2019 and 2020 MIPS reporting periods, which will help avoid payment penalties in 2021 and 2022.

CMS also considered the ongoing impact of the COVID-19 pandemic as it finalized rules for the 2021 QPP program year. CMS made fewer changes to the program than previously anticipated, and made smaller than anticipated changes in adjusting performance category weights to meet the statutory requirements established by MACRA.

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