A value-based reimbursement initiative introduced by the Centers for Medicare & Medicaid Services (CMS) to incentivize healthcare providers for delivering high-quality, patient-centered care.

Merit-Based Incentive Payment System (MIPS):

One of the two tracks within QPP where eligible clinicians are assessed based on performance metrics in categories such as quality, cost, improvement activities, and promoting interoperability.

Alternative Payment Models (APMs):

Another track within QPP where eligible clinicians participate in innovative payment models that emphasize care coordination, quality, and cost reduction, moving away from traditional fee-for-service reimbursement.

Eligible Clinicians:

Healthcare providers, including physicians, nurse practitioners, physician assistants, and others, who are eligible to participate in QPP based on their Medicare Part B billing.

Performance Categories:

The four components used to evaluate eligible clinicians under MIPS: Quality, Cost, Improvement Activities, and Promoting Interoperability (formerly Advancing Care Information).

Composite Performance Score (CPS):

The overall score that eligible clinicians receive based on their performance in the MIPS performance categories, determining the extent of their payment adjustments.

Payment Adjustment:

The positive or negative adjustment applied to Medicare Part B payments based on eligible clinicians’ performance in QPP. High performers receive positive adjustments, while low performers may face penalties.

Performance Threshold:

The minimum score required for eligible clinicians to avoid negative payment adjustments under MIPS. Meeting or exceeding the performance threshold is crucial for avoiding penalties.

Small Practice Bonus:

An additional incentive within MIPS designed to support small practices. Small practices may receive bonus points to boost their overall MIPS score.

Advanced APMs:

A subset of APMs within QPP that requires participants to take on more financial risk and meet specific criteria, including the use of certified electronic health record technology.

Patient-Centered Medical Home (PCMH):

A care delivery model that emphasizes coordinated, team-based care, often utilized by practices participating in QPP to enhance patient outcomes and reduce costs.

Quality Measures:

Specific metrics used to assess the quality of care provided by eligible clinicians. Quality measures cover various aspects of patient care and outcomes.