MACRA QPP Center

Physicians Advocacy Institute

Frequently Asked Questions Updated for 2020

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9. How is my QP/PQ determination made under the Medicare Count Methods and/or All-Payer Count Methods?

  • Under the Medicare Option, only payments and patients from Medicare FFS patients are considered. All-Payer Combination Option, there is a minimum threshold for Medicare patients/payments that must be met before the All Payer options kick in. The All-Payer options, therefore, do not replace or supersede the Medicare Option, and instead utilize a pair of calculations using first the Medicare Part B patient/payment count method, and then the All-Payer patient/payment count method for services furnished through Other Payer APMs.
      Medicare Payment Count Method Medicare Patient Count Method
    QP 50% of Medicare Part B payments are received through a Medicare Advanced APM 35% of Medicare Part B patients are seen through a Medicare Advanced APM
    PQ 40% of Medicare Part B payments are received through a Medicare Advanced APM 25% of Medicare Part B patients are seen through a Medicare Advanced APM
      All Payer Payment Count Method All Payer Patient County Method
    QP Step 1: Receive 25% of Medicare Part B payments are received through a Medicare Advanced APM
     
    Step 2: 50% of all payments are received through a Medicare Advanced APM and Other Payer Advanced APM
    Step 1: 20% of Medicare Part B patients are seen through a Medicare Advanced APM
     
    Step 2: 35% of all patients are seen through a Medicare Advanced APM and Other Payer Advanced APM
    PQ Step 1: Receive 20% of Medicare Part B payments are received through a Medicare Advanced APM
     
    Step 2: 40% of all payments are received through a Medicare Advanced APM and Other Payer Advanced APM
    Step 1: 10% of Medicare Part B patients are seen through a Medicare Advanced APM
     
    Step 2: 25% of all patients are seen through a Medicare Advanced APM and Other Payer Advanced APM
    For additional information, see the PAI’s Advanced APM Overview.



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