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November 1, 2022 – The Centers for Medicare & Medicaid Services (CMS) has published the CY 2023 Medicare Physician Fee Schedule (PFS) Final Rule, which includes policy changes for the Quality Payment Program for the 2023 performance year and beyond.

2023 Policy Highlights

The following are some of the key QPP policies that CMS finalized for the 2023 performance year and beyond:

MVPs

  • Introducing 5 new MVPs and revising the 7 previously established MVPs for reporting, beginning with the 2023 performance year.
  • Calculating administrative claims measures at the affiliated group Taxpayer Identification Number (TIN) level (of the affiliate group) when reporting as a subgroup.
  • Using the initial 12-month segment of the 24-month MIPS determination period to determine the eligibility of clinicians intending to participate and register as a subgroup.

MIPS (General)

  • Continuing to use the mean final score from the 2017 performance year/2019 payment year to establish the performance threshold for the 2023 performance year/2025 payment year (the performance threshold would be 75 points).
    • The exceptional performance threshold is set at 89 points.
  • Increasing the data completeness threshold to 75% for the 2024 and 2025 performance years.
  • Updating MIPS quality measures and the improvement activities inventory by:
    • Expanding the definition of “high priority measure” to include health equity-related quality measures.
    • Reducing the inventory of quality measures from 200 to 198, including the addition of 9 quality measures and the removal of 11 quality measures.
    • Making substantive changes to 76 existing quality measures, adding and removing measures for specific specialty sets, and partially removing 2 measures from the MIPS quality measure inventory (2 measures finalized for removal in traditional MIPS and finalized for retention in MVPs).
    • Adding 4 new improvement activities, modifying 5 existing improvement activities, and removing 6 existing improvement activities.
  • Updating the measure reporting requirements for the Promoting Interoperability performance category, including making the Query of Prescription Drug Monitoring Program measure required, beginning with the 2023 performance period; adding a third option, Participation in the Trusted Exchange Framework and Common Agreement, for satisfying the Health Information Exchange objective; and allowing APM Entities to report Promoting Interoperability at the APM Entity level.
  • Establishing a maximum cost improvement score of 1 percentage point out of 100 percentage points for the cost performance category.

Advanced APMs

  • Removing the 2024 expiration of the 8% minimum on the Generally Applicable Nominal Risk standard for Advanced APMs and making the 8% minimum permanent.

Related Initiatives

  • Details about updates to the Medicare Shared Savings Program included in the rule are available in the Shared Savings Program fact sheet.
  • For Care Compare, we’ll publicly report certain procedure information (utilization data) on individual clinician profile pages to aid patients in finding clinicians who may appropriately serve their needs. Please visit Care Compare for more details on public reporting.

Overview of QPP Policies in the CY 2023 Medicare PFS Final Rule – Webinar Details

CMS will host a webinar on November 16 to provide an overview of the final policies for the 2023 performance year. During this webinar, CMS will answer questions from attendees, as time permits.

For More Information

Learn more about the CY 2023 Medicare PFS Final Rule and QPP policy changes by reviewing the following resources:

  • Fact Sheet – Provides additional details about the finalized policies for QPP and other CMS initiatives.
  • 2023 Quality Payment Program Final Rule Resources:
    • 2023 QPP Policy Overview Fact Sheet – Outlines QPP policies in the CY 2023 Medicare PFS Final Rule for the 2023 performance year and beyond.
    • 2023 QPP Final Rule Policy Comparison Table – Showcases the changes to QPP policies after the publishing of the CY 2023 Medicare PFS Final Rule.
    • 2023 QPP Final Rule MVP Policies Table – Highlights the finalized MVP policy changes, beginning with the 2023 performance year.
    • 2023 QPP Final Rule FAQs – Answers common questions about QPP policies in the CY 2023 Medicare PFS Final Rule.
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