What your Medicare ACO needs to know about MACRA

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What your Medicare ACO needs to know about MACRAMEDICARE ACOS AND MACRA

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Quality Payment ProgramThe Quality Payment Program will reform Medicare Part B payments for more than 600,000 clinicians.

Clinicians will choose how they want to participate in the Quality Payment Program based on their practice size, specialty, location or patient population.

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Alternative Payment

Model (APM)

Advanced APM

Merit-based Incentive Payment System (MIPS)

MIPS or APM or Advanced APM

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MIPS

Who participates in MIPS?

MIPS Participants

Medicare Part B clinicians billing more than $30,000 a year AND providing care for more than 100 Medicare

patients per year

Physicians

Physician Assistants

Nurse Practitioners

Clinical Nurse Specialists

Certified Registered Nurse Anesthetists

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Who is excluded from MIPS?

Excluded from MIPS

Clinicians below the low-volume threshold

Medicare Part B clinicians billing less than or equal to $30,000 a year OR 100 or fewer Medicare Part B patients.

Newly-enrolled Medicare clinicians.

Clinicians who enroll in Medicare for the first time during a performance period are exempt from reporting on

measures and activities for MIPS until the following performance year.

Clinicians in an Advanced APM

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MIPS Eligible Clinicians Who Practice in Critical Access Hospitals Billing under Method II (Method II CAHs)

After consideration of the public comments we received, we are finalizing our proposal that the MIPS payment adjustment will apply to Method II CAH payments under section 1834(g)(2)(B) of the Act when MIPS eligible clinicians who practice in Method II CAHs have assigned their billing rights to the CAH.

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MIPS Eligible Clinicians Who Practice in Rural Health Clinics (RHCs) and/or Federally Qualified Health Centers (FQHCs)

After consideration of the public comments we received, we are finalizing our proposal that services rendered by an eligible clinician under the RHC or FQHC methodology, will not be subject to the MIPS payments adjustments. However, these eligible clinicians have the option to voluntarily report on applicable measures and activities for MIPS, in which the data received will not be used to assess their performance for the purpose of the MIPS payment adjustment.

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What are Medicare ACOs?

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Shared Savings Program

Track 1

Shared Savings Program

Track 2 and 3

Next Generation ACO

APM

MIPS eligible clinicians in ACOs

are subject to MIPS under the APM

scoring standard

All MIPS eligible clinicians in the

APM Entity are considered a group

and will receive the same score

Advanced APM

Participating eligible clinicians

who are determined to be

Qualifying APM Participants are

exempt from MIPS.

Advanced APM

Participating eligible clinicians

who are determined to be

Qualifying APM Participants are

exempt from MIPS.

https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf

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Participate in an Advanced

Alternative Payment Model

[Excluded from MIPS]

Test Pace MIPS Partial Year MIPS Full Year

Comprehensive List:

https://qpp.cms.gov/docs/QPP_Advan

ced_APMs_in_2017.pdf

Submit some data after January 1,

2017.

Neutral or small payment adjustment

Report for 90 day period after January

1, 2017

Small positive payment adjustment

Fully participate starting January 1,

2017

Modest positive payment adjustment

Pick your pace for participation in the MIPS transitional year 2017

Not participating in the Quality Payment Program for the transition year 2017 will result in a negative 4%

payment adjustment

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MIPS

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MIPS

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Quality Cost Improvement

Activities

Advancing Care

Information

APM Entity group

submits quality measure

data to CMS as required

under the APM.

ACOS use GPRO

No data submitted by

APM Entity group to

MIPS

No data submitted by

APM Entity group to

MIPS UNLESS the

assigned score at the

MIPDS APM level does

not represent the

maximum improvement

activities score, in which

case the APM Entity may

report additional

improvement activities

using a MIPDS data

submission mechanism.

Shared Savings Program

ACO participant TINs

submit data using a MIPS

data submission

mechanism. Next

Generation ACO Model

and other MIPS APM

eligible clinicians submit

data at either the

individual level or at the

TIN level using the MIPS

data submission

mechanism.

Table 14: APM Entity Submission Method for each MIPS Performance Category

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Advancing Care Information Performance Category1. CEHRT. Use CEHRT for the performance period.

2. Report MIPS – Advancing Care Information Objectives and Measures.

◦ Report the numerator (of at least one) and denominator, or yes/no statement as applicable, for each required measure; or Report a null value for each required measure that includes a null value as an acceptable result in the measure specification.

3. Support information exchange and the prevention of health information blocking and engage in activities related to supporting providers with the performance of CEHRT.

4. Implemented in a manner that allowed for the timely, secure and trusted bi-directional exchange of structured electronic health information with other health care providers, including unaffiliated providers, and with disparate certified EHR technology and health IT vendors.

https://qpp.cms.gov/measures/aci

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MIPS

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Quality Advancing Care

Group Practice Reporting Option (GPRO)

Clinical Information Reconciliation

Chronic Care Management (CCM)

Patient-Generated Health Data

Chronic Care Management (CCM)

Patient Empowerment Portal

Patient-Specific Education

Patient Empowerment Portal

Provide Patient Access

Patient Empowerment Portal

Secure Messaging

Patient Empowerment Portal

Send a Summary of Care Record

Request/Accept Summary of Care Measure

Chronic Care Management (CCM)

Patient Empowerment Portal

View, Download and Transmit (VDT)

Chronic Care Management (CCM)

Patient Empowerment Portal

How does Health Endeavors help MIPS APMs with MACRA?

Contact Us

Kris Gates, CEOgates@healthendeavors.com

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