Explanation of special status calculation for Quality Payment Program (QPP)

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Group of doctors standing consulting patient records on a tablet computer, close up view

The Centers for Medicare and Medicaid Services (CMS) has introduced new information on qpp.cms.gov that indicates whether clinicians have “special status” which would allow them to be considered exempt from the QPP.

To determine if a clinicians’ participation should be considered exempt from QPP which would include the Merit-Based Incentive Program (MIPS), CMS retrieves and analyzes Medicare Part B claims data. A series of calculations are run to indicate a circumstance of the clinician’s practice for which special rules under the Quality Payment Program will affect the number of total measures, activities or entire categories that an individual clinician or group must report. These circumstances are applicable for clinicians in: Health Professional Shortage Area (HPSA), Rural, Non-patient facing, Hospital Based, and Small Practices.

For more information, please visit the Quality Payment Program website.