mon-krecOn October 14, 2016, CMS released its final rule for the Quality Payment Program (QPP) authorized by the Medicare Access and CHIP Reauthorization Act (MACRA).

Kentucky REC presented a MACRA Final Rule Overview webinar to help organization’s understand how this will impact the way they deliver care.

To listen to the webinar, please click here.


The follow questions were asked on the webinar. We have answered the Frequently Asked Questions below:

1. Does MACRA/MIPS affect Medicaid clinicians? I do not participate in Medicare, only in Medicaid.
No, MACRA/MIPS only impacts providers who bill Medicare Part B at this time. However, similar changes to value-based payment are expected.

2. What if your RHC is a part of an ACO?
RHCs and FQHCs must first determine eligibility dependent upon whether or not the RHC/FQHC bills at least $30,000 in Medicare Part B and/or bills for 100 Medicare patients (dependent upon whether you are reporting as an individual or group). If the RHC/FQHC is determined to be eligible, then you must determine whether or not your ACO is considered an Advanced Alternative Payment Model (APM) or a MIPS APM. If 20-25% of your Medicare Part B billing is through an Advanced APM, then RHCs or FQHCs may qualify for a 5% lump sum bonus.

3. Can you report on any 90-day period for Advancing Care Information?
Yes, you can report any consecutive 90 day period between January 1, 2017 and December 31, 2017. We recommend that you find your best 90 day period and report on that timeframe before March 31, 2018.

4. Under Advancing Care Information some objectives are eligible for a percentage bonus. Can you receive multiple bonuses for this category?
Yes, you can report multiple objectives to receive bonus points. Each objective has a set percentage of bonus associated with reporting.

5. If a provider get a penalty’s for 2017+ and s/he moves to a different organization will that penalty follow the provider?
Yes. Just like other quality programs, the penalties/incentives follow the provider.

6. Will we still have to do Medicaid MU for individual providers?
Yes, if you want to continue receiving an incentive for the Medicaid EHR Incentive Program, you will need to continue to attest under the guidelines of the Kentucky Department of Medicaid Services. The Medicaid EHR Incentive Program is funded through 2021.

7. Will all of those penalties be stacked for each year?
No. The penalties are only associated with the performance year in which they were incurred.

8. Where do I find information about Patient Centered Medical Home and Patient Centered Specialty Practice Recognition?
You can visit Kentucky REC’s website at or you can contact us at 859-323-3090 or for information related to Patient Centered Medical Home or Patient Centered Specialty Practice Programs. Kentucky REC has certified content experts on staff to help your practice achieve recognition.

9. Are CPOE and CDS still required for 2016 MU reporting for physician offices?
Yes. Changes to CPOE and CDS rules will impact 2017 Meaningful Use.

10. For the Meaningful Use program there was a very detailed document on the CMS website detailing what each measure required. Is there something similar that talks about each measure/requirement in detail for MIPS?
Yes. Visit CMS’s new Quality Payment Program website at

11. Is full year reporting required for MIPS?
Each performance category has a required reporting timeframe that is dependent upon the performance year. Therefore, for 2017, you have 4 options available to you which will determine the reporting timeframes for each performance category. Visit QPP website for further details.

12. Can you report quality as a group as with PQRS or is everything reported by individual provider?
Each performance category can be reported as a group/TIN or as an individual EC /NPI.

13. Do I need to sign-up for this program?
No, technically there is no registration required. However, registration may be required for certain methods of submission (i.e. GPRO or CMS Web Interface). It is important to keep your PECOS up to date as well.

14. This system does not seem to empower providers to tackle the larger issues that accompany patients of low income/low education.
The QPP program is intended to improve quality and reduce avoidable cost for all patients. For many clinicians value-based and alternative payment models incentivize them to provide additional support for vulnerable and high-risk patients.

15. Can you explain the extra credit for the Improvement Activities?
Certain Improvement Activities which are identified in the list found on CMS’s website can be submitted/performed using your Certified Electronic Health Record (CEHRT) and these activities can qualify you for bonus points.

16. What ACO organizations are there in this area?
There are many to choose from. Visit for a map of the APMs in Kentucky. The QPP site also has a list of available APMs.