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Information Articles: Medicare and Medicaid

Medicare Releases Quality Payment Updates for 2019

Wednesday, November 7, 2018   (0 Comments)
Posted by: Mario Fucinari DC, CCSP, MCS-P, CPCO
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Medicare Releases Quality Payment Updates for 2019


On November 1, 2019, year 3 of the Medicare Quality Payment Program (QPP) key factors were released.  Beginning January 2019, the definition of eligible providers has been expanded to include physical therapists, occupational therapists, speech-language pathologists, audiologists, clinical psychologists, and registered dietitians or nutrition professionals.

Next year, providers may choose to opt into the program, even if they have not exceeded the low-volume threshold.  In the past, a provider would have had to exceed 200 active patients and perform more than $90,000 in part B Medicare services.  This threshold eliminated 85% of chiropractors.  This threshold has been changed to allow providers to participate in the QPP if they only meet one of the thresholds.   The program has added a third element (Number of Covered Professional Services) to the low-volume threshold determination and provides an opt-in policy that offers eligible clinicians who meet or exceed one or two, but not all, elements of the low-volume threshold, the ability to participate in MIPS.

The program continued to improve by moving clinicians to a smaller set of objectives and measures with scoring based on performance for the Promoting Interoperability performance category.  The program will also begin to allow small practices to submit quality data for covered professional services through the Medicare Part B claims submission type for the Quality performance category.

Several chiropractic physicians have expressed no inclination to participate in the quality payment program.  However, it is recommended that all providers educate themselves on the Quality Payment Program and Medicare’s Physician Compare Program.  Beneficiaries are being encouraged by Medicare to look up their physicians to see how they rate in performance related to quality care.  Patient survey scores are also being published. The survey asks patients about their experiences with clinicians in the groups they visit for care. It covers important topics, such as how well their clinicians communicate.

The QPP is only one of the programs the government uses to recognize and reward with increased reimbursement those physicians who provide quality care to their patients and eliminate fraud, waste and abuse. The program is seriously being evaluated by commercial carriers such as Blue Cross and Aetna.

More information may be found at:

The ICS will be presenting several classes in 2019 with Dr. Mario Fucinari.  Mario Fucinari DC, CCSP, MCS-P, CPCO is a Certified Professional Compliance Officer, Certified Medical Compliance Specialist and a member of the Medicare Carrier Advisory Committee.  He is a frequent national speaker for ChiroHealthUSA, NCMIC and Foot Levelers.  Dr. Mario has been in full-time practice in Decatur, IL since 1987. For further information, please contact him at or visit his website at for products and services.



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