MACRA and How To Prepare

MACRA Glossary of Acronyms and Terms

Top 10 Things You Need to Do for MACRA

THINGS YOU NEED TO DO FOR MACRA

Top 10 Things You Need to Do for MACRA

With MACRA implementation on its way, here are the most important things you must do to be ready for its arrival.

1. Learn about the "new" Quality Payment Program at Center for Medicare/Medicaid Services (CMS) to implement MACRA.

2. Meet CMS objectives for Meaningful Use (MU) of your EHR to qualify for the EHR Incentive Program for 2016.

3. Understand and participate in the Physician Quality Reporting System (PQRS) program for 2016.

4. Implement a formal quality improvement process to improve your reported PQRS and MU quality measures. Ensure that your care adheres to accepted clinical guidelines.

5. Review your Quality Resource Use Report (QRUR) for accuracy. Contact CMS if there are problems.

6. Use a CMS-certified vendor for collection of Consumer Assessment of Healthcare Providers and Systems (CAHPS) data. This is required for practices with >100 clinicians for 2016 reporting

7. Understand the principles of the Patient-Centered Medical Home and begin implementing them in your practice.

8. Participate in a "medical neighborhood" and provide care coordination to reduce unnecessary visits and testing.

9. Impanel and risk-stratify your patient population, and implement care management for those at high risk for hospitalization or ER visits.

10. Become educated on ACP’s High Value Care recommendations and implement them in your practice to prevent unnecessary testing and procedures.

Merit-Based Incentive Payment System

HPP Management Group and AccuChecker has helped practices successfully navigate PQRS and Meaningful Use. We’ll use the same proven approach to helping clients succeed with MACRA.

The  Medicare Access and CHIP Reauthorization Act of 2015  (MACRA) promotes the transition to quality-based payment by implementing two payment pathways for clinicians. Starting in 2019, clinician payment for Medicare Part B services will align under two pathways: the Merit-Based Incentive Payment System (MIPS) or participation in eligible Alternative Payment Models.

Understanding Risk , reviewing the necessary steps PRIOR to the face-to-face encounter,  and scrubbing the claim prior to submission will have a positive affect on your practice. Failure to comply will impact your revenue.

The MIPS program will involve positive or negative payment adjustments to the Medicare Physician Fee Schedule (“PFS”) payments. MIPS payments under this program are a zero sum game because of MACRA’s required budget neutrality. This means that the money CMS saves from the negative adjustments will be used to fund the positive adjustments. Additionally, from 2019 through 2024, the best performing physicians will be eligible for an additional bonus payment of up to 10% allocated from a $500 million pool.

For more details on how HPP Management Group and AccuChecekr can help you, please contact :  pesilverio@hppcorp.com  or support@accuchecker.com

305-227-2383   /  1-877-938-9311  / 786-231-7585

Path To Value 20160513a

Path to Value

New Goals for value-based payments and APMs in Medicare

The new Merit-based Incentive Payment System helps to link fee-for-service payments to quality and value.

The law also provides incentives for participation in Alternative Payment Models in general and bonus payments to those in the most highly advanced APMs

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a bipartisan legislation signed into law on April 16, 2015.

What does Title I of MACRA do?

• Repeals the Sustainable Growth Rate (SGR) Formula

• Changes the way that Medicare rewards clinicians for value over volume

• Streamlines multiple quality programs under the new Merit Based Incentive Payments System (MIPS)

• Provides bonus payments for participation in eligible alternative payment models (APMs

MIPS changes how Medicare links performance to payment MACRA streamlines those programs into MIPS:

·         Merit-Based Incentive Payment System (MIPS)

·         Physician Quality Reporting Program (PQRS)

·         Value-Based Payment Modifier

·         Medicare HER Incentive Program

Understanding the NEW payment models is key to being successful. AccuChecker now offers you a pathway to SUCCESS. ACKScrubber will determine if your claim is correct, if you have a missed opportunity, or alert you the proper coding required to qualify a specific measure.

For more details contact us at :   support@accuchecker.com

Or call :  786-231-7585  /  305-227-2383  /  1-877-938-9311

Quality Payment Program: Delivery System Reform, Medicare Payment Reform, & MACRA 20160513

Quality Payment Program: Delivery System Reform, Medicare Payment Reform, & MACRA

The Merit-Based Incentive Payment System (MIPS) & Alternative Payment Models (APMs) 

How does the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) reform Medicare payment?

The MACRA makes three important changes to how Medicare pays those who give care to Medicare beneficiaries. These changes create a Quality Payment Program (QPP):

·         Ending the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services.

·         Making a new framework for rewarding health care providers for giving better care not more just more care.

·         Combining our existing quality reporting programs into one new system.

These proposed changes, which we’ve named the Quality Payment Program, replace a patchwork system of Medicare reporting programs with a flexible system that allows you to choose from two paths that link quality to payments: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models.

What's the MACRA Quality Payment Program?

The MACRA QPP will help us to move more quickly toward our goal of paying for value and better care. The Quality Payment Program has two paths:

Merit-Based Incentive Payment System (MIPS)

Alternative Payment Models (APMs)

MIPS and APMs will go into effect over a timeline from 2015 through 2021 and beyond.

What’s the Merit-Based Incentive Payment System (MIPS)?

The MIPS is a new program that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one single program in which Eligible Professionals (EPs) will be measured on:

·         Quality

·         Resource use

·         Clinical practice improvement

·         Meaningful use of certified EHR technology

  

Understanding how the various quality measure and participation  will affect your reimbursement is key to your success. AccuChecker  offers you a solution with the  ACKQuality Measure Scrubber.

Our system alerts you to potential measures that can be captured, missed opportunity , and how to correctly code to qualify the measure.

For more details on the ACKScrubber , please contact us at ;    support@accuchecker.com

Or call us at  :  786-231-7585  /   305-227-2383    /  1-877-938-9311

Quality Measures 02/26/2016

Quality measures

Quality measures are tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.

Failing to understand or comply with the various Quality Measures, can cost you.

Quality measures can take many forms, and these measures evaluate care across the full range of health care settings, from doctors’ offices to imaging facilities to hospital systems.

Currently, the most common uses of quality measurements include public reporting, provider

incentive programs, and accreditation and/or certification of providers and health plans. 

One key step in this effort is the creation of the National Quality Strategy, the first comprehensive federal undertaking aimed at improving the quality of care in this country. The Affordable Care Act required the secretary of Health and Human Services (HHS) to establish this national strategy for improving health care that set priorities and that provided a plan for achieving its goals: better care, affordable care, and healthier people and communities. 

HPP Management Group, Corp., provides training and interactive workshops to groups and organizations in a professional and solution-focused atmosphere. The consultants and trainers are proven experts in their field utilizing the latest learning success strategies and are certified professionals. Our selected team also provides condensed versions of each of the interactive full-day or half-day workshops as one-hour seminar.

·         Assessment Planning & Tool Development

·         Principles

·         Potential Shareable Savings Based on Quality Measurement

·         Measure Categories and Weighting

·         Data

·         Measures

·         Scoring

 

Call HPP Management Group, Corp for more details: 786-231-7585  or  305-227-2383

Understanding The Quality Measures

The Institute of Medicine defines health care quality as "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."

Quality Domains

The Institute of Medicine further defines quality as having the following properties or domains:

Institute of Medicine (IOM) Domains

·         Effectiveness. Relates to providing care processes and achieving outcomes as supported by scientific evidence.

·         Efficiency. Relates to maximizing the quality of a comparable unit of health care delivered or unit of health benefit achieved for a given unit of health care resources used.

·         Equity. Relates to providing health care of equal quality to those who may differ in personal characteristics other than their clinical condition or preferences for care.

·         Patient centeredness. Relates to meeting patients' needs and preferences and providing education and support.

·         Safety. Relates to actual or potential bodily harm.

·         Timeliness. Relates to obtaining needed care while minimizing delays.

 

Penalties for Failure to Report:  For fiscal year 2014, and each subsequent  year, failure to submit required quality data shall result in a 2 percentage point reduction to the market basket percentage increase for that fiscal year.

·        Is your practice and/or organization prepared to the meet  the quality measures that are in effect?

·         Are you prepared to satisfy an audit in the event  CMS decides to review your charts ?

·         Have you satisfactorily code/billed for the various measures?

 

For more information contact HPP Management Group, Corp.

305-227-2383  or 1-877-938-9311

psilben@hppcorp.com