The Centers for Medicare & Medicaid Services (CMS) has published the 2018 final rule to regulate the Quality Payment Program under Medicare Access and CHIP Reauthorization Act (MACRA). The Quality Payment Program is an initiative for general practitioners and other qualified healthcare providers seeking incentive payments in either of the ways: 1) With the help of the Merit-based Incentive Payment System (MIPS). 2) By implementing the Advanced Alternative Payment Models (APMs). This final rule comprises of some main changes that can directly affect payments of the healthcare providers. Also, the final rule is inclusive of custom-made flexibilities for the practitioners working at a smaller level. The modifications in these rules from the altering year are planned to present clinicians more ways to take part in the program productively. Below are some significant modifications that the federal Centers for Medicare & Medicaid Services (CMS) published in Quality Payment Program (QPP) final rule year 2018. The medical and healthcare providers will be responsible for providing value-based care. The weight of the Quality Performance Category will remain at 60 percent for the performance year 2018. There are additional benefits which the CMS has allocated for small practices in the form of bonus points. Small practices will be awarded additional points to their MIPS final score if they report performance data. Practitioners can earn five extra points if they deal a complex population of patients. More small practices are exempt from The Quality Payment under the new rule. In the Final Rule 2018, CMS has expanded the low-volume threshold and exempted providers with less than $90,000 in Medicare Part B allowed charges which mean that 123,000 more providers will exempt from MIPS in 2018. Small practices and solo practices can form a virtual group to participate under MIPS. Individual practitioners and healthcare providers in clusters of 10 or less can practically be in collaboration, by disregarding their geographic setting or clinical area of expertise, and can form a virtual group before December 1, 2017, to participate under MIPS. There will be a relief for clinicians with regards to reporting and penalties who situate in an area with the natural disaster. It lets the practitioners who report under MIPS, exemption from data submission and penalties if they serve in an area hit by any natural calamity including hurricanes, emergencies of public health and natural disasters. There will be a more significant room for information in the final rule on MIPS APMS. This is valid for those healthcare providers who are taking part in APMs but do not fulfill the criteria to be eligible for Advanced APMs. There is also the addition of determination interlude for MIPS APMs in the final rule, which lets additional Medicare Shared Savings Program providers be eligible as MIPS APMs. CMS to would be more flexible in 2018 to allow more participants to qualify for APMs under the QPP. CMS has included ACO track one model as an advanced APM to double the APMs participation under the QPP. There are also added particulars on the All-Payer Combination Model. Providers will be able to qualify as Advanced APMs through a combination of Medicare and other Payer Advanced APMs. CMS added flexibilities in using Certified Electronic Health Record Technology (CEHRT). Clinicians are allowed to continue using 2014 edition of Certified Electronic Health Record Technology (CEHRT), rather than upgrading to 2015 Edition of the system, to report the Advancing Care Information (ACI) transition measures. In this more flexible version of MACRA final rule, CMS has reduced the regulatory burden of MACRA on providers, and it is open to comments until Jan. 2, 2018.