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Daily Practice

Quality Payment Program

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program (QPP). QPP transitions Medicare payment away from fee-for-service to pay-for-performance, emphasizing quality care. The program represents a significant change in the way all physicians, including radiation oncologists, are paid by Medicare.

Participation in the QPP is split between the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM); however, within those two branches is a lot of variation. The following links provide a deeper dive into the details of each model:

Physicians can look up eligibility and reporting requirements on the QPP website using their National Provider Identification (NPI) number. Information will include CMS’ analysis of the number of Tax Identification Numbers (TINs) associated with your NPI including MIPS eligibility, APM enrollment, hospital-based designation (more than 75% of services are billed at the hospital), and small practice designation (15 or fewer eligible clinicians) and facility-based scoring. This information will be provided for both the individual (NPI) and group level (TIN). This is a valuable resource to determine clinician specific program requirements, as well as ensure that CMS has the correct information regarding your practice.

The MIPS program started with a +/-4% payment adjustment based on the 2017 MIPS performance. This adjustment has increased over the years and is now a possible 9% on 2026 Medicare payments.

Participation
Timeline
Score and Payment Attribution

ASTRO and CMS have many resources to help you determine the best path for your practice. Contact ASTRO for more information.

Measures Measures are a mechanism to assess quality indicators in various aspects of the delivery of health care and may be used internally or externally with a direct link to physician reimbursement.