MACRA is the Medicare Access and CHIP Reauthorization Act, which is a federal legislation signed into law in 2015, that replaced the Sustainable Growth Rate (SGR).
It outlines a new program for physician reimbursement that replaces fee-for-service with value-based payments under the Quality Payment Program (QPP).
What is the Quality Payment Program (QPP)? The Quality Payment Program (QPP) is the portion of MACRA that defines the new value-based reimbursement system for physicians who provide care for Medicare Part B patients, shifting from the current fee-for-service model to value-based care.
The Quality Payment Program (QPP) establishes two reimbursement tracks: Merit-based Incentive Payment System (MIPS) and Advanced APMs (AAPM).
The Merit-based Incentive Payment System (MIPS) is one of two new payment tracks under Quality Payment Program where you earn a performance-based adjustment to your Medicare payment.
This track consolidates three existing programs: (Meaningful Use, Physician Quality Reporting System and Value-Based Modifier) with the addition of a new component called Improvement Activities.
Most providers will participate in MIPS not Advanced APMs in 2017. Under MIPS, providers’ Medicare reimbursements will be adjusted up or down based on how they score across 3 categories:
Replaces the old PQRS system, but is very similar in that it requires providers to report on quality measures.
Replaces Medicare Meaningful Use, but is very similar in that it requires providers to use a certified EHR to report measure objectives.
Practices must attest that they have implemented documentation, workflow, or process improvements.
An Alternative Payment Model (APM) is a new approach to paying for medical care through Medicare that incentivizes quality and value.
As defined by the law, APMs include: the Centers for Medicare & Medicaid Services’ (CMS) Innovation Center Model, Medicare Shared Savings Program (MSSP), demonstration under the Health Care Quality Demonstration Program, or a demonstration required by federal law.
An Advanced Alternative Payment Model (AAPM) is an APM that has met the statutory APM requirements, as well as three additional criteria:
Workflow Management & Optimization is ready to deliver 100% Success Results.
Workflow Management & Optimization is committed to helping healthcare providers through the entire program life cycle.
Our dedicated Merit-Based Incentive Payment System (MIPS) consulting team reviews and analyzes client performance while providing training, education and support.
Quality Payment Program (QPP) requirements are integrated into every day workflow for easy compliance in order to avoid penalties and strive for bonuses.
Workflow Management & Optimization has a vast experience in consulting and training heathcare providers to exceed Quality Payment Program (QPP) guidelines and comply with Centers for Medicare and Medicaid Services (CMS) audits.
Our main focus is on delivering quality MacraCare while our dedicated Merit-Based Incentive Payment System (MIPS) consulting team reports for you.
We are ready to deliver results for every healthcare provider that has signed up for Quality Payment Program (QPP) consulting.
The following are the approved Advanced APMs for 2017.
Comprehensive ESRD Care (CEC) – Large Dialysis Organization (LDO)
Comprehensive ESRD Card – Non-LDO
Comprehensive Primary Care Plus (CPC+)
Next Generation ACO Model
Shared Savings Program – Track 2
Shared Savings Program – Track 3
Oncology Care Model (two-sided risk arrangement)
If you receive 25% of Medicare payments or see 20% of your Medicare patients through an Advanced APM, then you may earn a 5% incentive payment in 2019.
You do not participate in MIPS. You will report your data through your APM.