The Centers for Medicare & Medicaid (CMS) is releasing the Quality Payment Program (QPP) computer code responsible for calculating quality measures from Medicare claims data submitted by eligible clinicians via Quality Data Codes (QDCs). This code is intended for developers interested in the calculation mechanism supporting QPP Claims to Quality. If QPP is part of your job as a medical coder, you’ll like this.

CMS uses modern data processing techniques to improve the way it processes quality measures submitted via Medicare claims and to allow eligible clinicians frequent visibility into their individual scores.

QPP Data Processed

All required claims data is processed from the Integrated Data Repository on a regular basis and all 74 QPP claims measures are calculated. The scores are then translated to a JSON format and submitted via an Application Programming Interface (API).  The results are used to determine eligible clinicians’ quality performance category scores, which then are used as part of the calculation of eligible clinicians’ QPP final scores.

Accessing QPP Code

The code available is a showcase of the calculation mechanism behind QPP Claims to Quality measures. Access to the production databases was removed so the code is not plug and play. However, developers can use the code to run calculations by using calculate_measure_from_csv.py or by building their own script.

The repository can be accessed publicly on GitHub here: https://github.com/CMSgov/qpp-claims-to-quality-public. We welcome issue creation to notify of bugs, errors, or ask questions. The

The code is licensed under CC0 1.0 Universal. As such, there is no limitation on usage, but also no warranty and support. You can access the complete license here.