New Medicare reporting requirements: MACRA, MIPS & APMs Key Dates & Deadlines

Posted by Continuum on Feb 28, 2017 11:00:00 AM

As many physicians are aware, major changes are underway in how Medicare will reimburse them. The Centers for Medicare and Medicaid Services (CMS) is phasing in new reporting requirements focusing on “value” of care: measures of quality, overall cost of care, and patient satisfaction. Increasingly, how doctors address these new requirements will directly affect their reimbursement – potentially leading to financial rewards or penalties. Moreover, commercial payers are starting to follow Medicare’s lead. 

Here’s a quick refresher on the basics, including important dates for most physicians who see Medicare patients:  

  • The Medicare Access & CHIP Authorization Act (MACRA) of 2015 requires doctors to choose a reporting path – either the Merit-Based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (Advanced APM).
  • MIPS is comprised of Quality, Improvement Activities, Advancing Care Information, and Cost. MIPS payment adjustments will start at +/-4% for the 2017 reporting year (2019 payment year) and increase over time. (Cost will not affect payment adjustments until 2018).
  • Advanced APMs offer higher financial incentives than the MIPS track, but require more advanced levels of value-based activities. APMs also require physicians to be part of a larger group, such as an accountable care organization (ACO) or medical home, and to bear greater financial risk.
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Topics: MIPS, APMs, MACRA

The medical home model: What physicians need to know

Posted by Continuum on Nov 1, 2016 1:08:19 PM

The concept of a “medical home” has evolved over the years, starting in the 1960s as the center of medical records for a child with special healthcare needs. Today, that definition is greatly expanded: A medical home is a partnership between the patient, family and primary care provider, in cooperation with specialists and community supports, according to the U.S. Department of Health and Human Services. It can encompass children and adults, regardless of their healthcare needs.

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Topics: Value-Based Healthcare, MIPS, APMs

Medicare Quality Data: Who Must Report?

Posted by Continuum on Aug 16, 2016 11:00:00 AM

Starting next year, most doctors will be required to report quality data under Medicare’s new Merit-Based Incentive Payment System (MIPS). MIPS will apply to other clinicians, too, such as physician assistants and nurse practitioners. However, many thousands of practitioners will be exempt from these requirements, if they meet certain criteria.

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Topics: value-based reimbursement, MIPS, APMs, Alternative Payment Models

Is Your Practice Ready for CMS Reimbursement Changes?

Posted by Continuum on Mar 29, 2016 11:00:00 AM

Changes to Medicare will soon have a major impact on physicians’ bottom lines.The Centers for Medicare and Medicaid
Services (CMS) is fast-tracking its shift to value-based payments, with the introduction of new regulations, reporting requirements and financial consequences.

As a result, physicians could experience a substantial difference in their Medicare Part B payments. Whether that change is positive or negative,though, depends upon their preparedness.

For most private-practice physicians, the situation demands immediate attention. That’s because each year’s reported data – for 2016 and beyond – will affect payments two years later. Moreover, Medicare is switching from an incentive-based system to one with mounting penalties. Independent practices are especially vulnerable due to the complexity of these changes. Larger practices will be affected first, then smaller groups, and finally, solo practitioners.

Act Now -- Or Lose Ground

Doctors can take incremental steps to get ready, but it's vital to move forward now. For physicians, it’s sink-or-swim time. The waters of this paradigm shift are about to surge dramatically and will continue to rise each year after 2016.Virtually all doctors will be affected by these changes, which include substantial penalties for those who underperform on quality and cost measures in comparison to their peers. On the plus side, physicians who perform well under the new rules will receive additional reimbursement from Medicare.

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Topics: Value-Based Modifer, Merit-Based Incentive Payment System, MIPS, CMS, Medicaid

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