Making Sense of MACRA: The AAFP’s Top 10 Frequently Asked Questions


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This supplement provides answers to frequently asked questions to help physicians successfully participate in and navigate the QPP.

Fam Pract Manag. 2018 Sep-Oct;25(5):9-12.

1. How do I find out if I am required to participate in the Quality Payment Program (QPP)?

Eligible clinicians (ECs) for the 2018 performance period include medical doctors, doctors of osteopathy, nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse anesthetists. Eligible clinicians can verify their eligibility status in the QPP by entering their national provider identifier (NPI) number in the QPP Participation Status Tool. The tool provides eligibility status for the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (AAPM) qualifying participant status.

A clinician may be excluded from MIPS if they:

• Provided care to less than 200 Medicare Part B beneficiaries or received less than $90,000 in Medicare Part B payments (referred to as the low-volume threshold); or

• Are in their first year of Medicare participation; or

• Qualify for the AAPM bonus.

The Centers for Medicare & Medicaid Services (CMS) will calculate an EC’s low-volume threshold status by using two sets of claims data. For the 2018 performance period, the first data set will include claims data from September 1, 2016, to August 31, 2017. The second data set will include claims data from September 1, 2017, to August 31, 2018. ECs who fall below the low-volume threshold in either determination period are excluded from MIPS for the performance period. An EC will receive a low-volume threshold determination for each tax identification number (TIN) where the EC practiced during the performance period.

2. Do I need to register to report?

No. Registration is only required for those wishing to report using the CMS Web Interface or those using Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS. Groups that registered to use the CMS Web Interface for the 2017 performance period do not need to re-register. However, cancelations or changes to a group’s registration needed to be made before the registration d


Copyright © 2018 by the American Academy of Family Physicians.
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