Medicare Quality Payment Program Update

The Centers for Medicare & Medicaid Services (CMS) is adding registered dietitian nutritionists as eligible healthcare professionals to its Medicare Quality Payment Program (QPP) beginning January 1, 2019. As such, if you are a Medicare provider, you will be able to report outcomes to the CMS and potentially receive an increase in your payments come 2021.

Let’s explore the details – but first, what is the QPP? Following a re-arrangement of Medicare programs, the QPP emerged and houses various quality and reporting programs. Under the program, payments for Medicare Part B services will fall under pay-for-performance instead of fee-for-service, in order to foster more holistic patient care rather than treating a client’s relationship with the healthcare system as being comprised of a series of disparate and disconnected services. The QPP provides you with opportunities to increase your reimbursement rate via two tracks.

Quality Payment Program: Comprised of Two Tracks

The QPP is comprised of two tracks. Track one provides a Merit-Based Incentive Payment System (MIPS), a track under which RDNs can report and potentially gain additional financial incentive in the form of improved reimbursement rates based on performance-based initiatives. MIPS has four performance scoring categories by which you may gain return on your counseling outcomes: quality, cost, improvement activities and promoting interoperability. Access the CMS’ MIPS resource library for detailed information or visit the Academy’s MIPS 101 page to learn more.

Track two of the QPP is the Advanced Alternative Payment Models (Advanced APMs), which has been in effect since 2017 and allows RDNs to potentially qualify for annual bonuses. According to the Academy of Nutrition and Dietetics, “The QPP allows RDNs to demonstrate the importance of their profession as well as the value RDNs bring to clients, the health care team and organizations.”

Take These Steps to Qualify for Potential Increased Return

The team here at Healthy Bytes realizes that navigating Medicare can be tricky – that’s why we’re here to do this on your behalf! Here’s what this news means for you. First, know that this development, whereby reimbursement may increase, will not go into effect until 2021. Phase 1, however, where you as an RDN can become an eligible clinician for this program, is something that becomes available to you in 2019.

Learn whether you are an eligible RDN by entering your NPI number on the CMS’ Quality Payment Program website. If you’re eligible for the MIPS program, you will choose whether to participate at the individual or group level. You will then collect your performance data for services for 2018 and voluntarily submit your data to Medicare by the deadline of March 31, 2019.

Even though reimbursement itself won’t change for a few more years, the process of joining Medicare or of updating your existing information to indicate that you’re a participating QPP program provider can be lengthy. If you are a qualifying RDN, you will receive a payment adjustment in a few years based on the data submitted, which will affect your Medicare Part B payments for covered professional services. Get started now!


Again, Healthy Bytes is here to help! Do reach out to us for support so that we can help you potentially increase your Medicare reimbursement rates.