Medicare's Quality Payment
Program (QPP)



The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) repealed the broken Medicare sustainable growth rate (SGR) formula and established new payment pathways for physicians. To implement MACRA's reimbursement reforms, the Centers for Medicare & Medicaid Services (CMS) developed the Quality Payment Program which includes:

  • the Merit-Based Incentive Payment System (MIPS), as a modifier for fee-for-service payments beginning in 2019.
  • Alternative Payment Models (APMs).

Ensuring Pathologists Participation in QPP

The CAP has engaged with Medicare officials to mitigate the negative effects of new and evolving reporting requirements for pathologists and laboratories. Through a strategy developed by the Council on Government and Professional Affairs and Economic Affairs Committee, the CAP advocates to ensure pathologists can participate in the Quality Payment Program. The CAP also provides resources and updates on Medicare payment reform to its members as the CMS implements and administers MIPS and APM programs.

NEW: The CAP has developed a resource to help pathologists participating in MIPS determine which Improvement Activities to attest to in 2018. Clinicians need to attest to Improvement Activities, which represents 15% of a pathologist’s MIPS score, in order to receive credit in this category. View the 2018 Improvement Activities for pathologists .

View the MACRA Infographic »

View and Complete the MACRA Readiness Checklist »

Understand Your MIPS Reporting Options »

View pathology-specific quality measures »

MIPS Clinician Eligibility Look Up Tool

Pathologist group practices can now check their eligibility for the 2018 MIPS performance year by using the MIPS Participation Lookup Tool. This CMS tool is available to check 2018 MIPS individual and group reporting eligibility. Since the Participation Lookup Tool is now available, the CMS will no longer send out eligibility letters to physicians in 2018.

In the past, the eligibility look-up tool was only searchable by individual National Provider Identifier (NPI). After groups log into the CMS updated website using Enterprise Identity Management (EIDM) credentials, they will be able to see the eligibility status for every clinician in the group and determine who needs to participate in MIPS in 2018.

After logging into the feature using your EIDM credentials, browse to the Taxpayer Identification Number (TIN) affiliated with your group, and you will be able to access a details screen to see the eligibility status of every clinician based on their NPI and find out whether they need to participate during the 2018 performance year for MIPS.

You can also use the MIPS Participation Lookup Tool to find out whether individual clinicians are eligible for the 2018 performance year without needing to login to the feature. Keep in mind that exempt individual clinicians still will need to report if their group is eligible and chooses to report as a group.

MIPS Calculator

Use our MIPS calculator to help estimate future Medicare payment adjustments based on your practice data and project how MIPS will impact your practice's finances. Note this tool is for informational and estimation purposes only.

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Check your practice's readiness for MACRA