Video shows how to avoid Medicare payment penalties
The Quality Payment Program (QPP) is the new physician payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA) and is administered by the Centers for Medicare and Medicaid Services (CMS). Because the QPP is new this year, MSMA and the AMA want to make sure physicians know what they have to do in 2017 to participate and the QPP’s “pick your pace” options for reporting. This is especially important for those physicians who have not participated in past Medicare reporting and programs and may be less knowledgeable about the steps they can take to avoid being penalized under the QPP.
The AMA, MSMA, and other physician groups stressed to CMS the importance of establishing a transition period to QPP and, as a result, physicians only need to report on at least one quality measure for one patient during 2017 in order to avoid a payment penalty in 2019 under the Merit-based Incentive Payment System (MIPS).
A new short video developed by the AMA, “One patient, one measure, no penalty: How to avoid a Medicare payment penalty with basic reporting,” offers step-by-step instructions on how to report so physicians can avoid a negative 4% payment penalty in 2019. The video can be viewed on this website, ama-assn.org/qpp-reporting, where there are also links to CMS’ quality measure tools and an example of what a completed 1500 billing form looks like.
CMS has posted a very helpful Fact Sheet that lets you know what you can do to qualify for positive payment updates, and what you need to do to avoid payment penalties.
Additionally, the AMA has put together a very good MACRA website chock-full of excellent resources - Medicare Physician Payment Reform
Contact Tom Holloway or call 800-869-6762.
CMS issues final MACRA Quality Payment Program rule
On October 14, the Department of Health and Human Services issued its final rule to implement the Quality Payment Program (QPP) which was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to replace the flawed Sustainable Growth Rate formula for updating the Medicare physician fee schedule.
The final rule – a tortuous 2,205-page manifesto and alphabet soup of federal acronyms – sets forth two main options for participating physician practices to consider: The Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). The QPP intends to move the Medicare payment methodology to reward high-value, patient-centered care. Central to that goal are certain activities and data reporting that physicians will undertake to measure performance. The first payment adjustments – both positive and negative – will go into effect on January 1, 2019. But 2017 will begin the transition period for collecting and submitting data.
The MIPS Option
MIPS is a reporting/measurement program that replaces (and retains elements of) three current Medicare reporting initiatives: Meaningful Use, PQRS, and the Value-Based Payment Modifier. MIPS measures performance in four categories: Quality, Advancing Care Information, Cost, and Improvement Activity. Most physician practices are expected to exercise this option. Here are some things to know about MIPS:
The Advanced APM Option
An Advanced APM is a model that can earn more for taking on some risk related to patient outcomes. In general a qualified APM must be CMS Innovation Center, Shared Savings Program, or other federally qualified demonstration project. It must require participants to use certified EHR technology, base payments for services on quality measures comparable to those in MIPS, be a Medical Home Model expanded under Innovation Center authority, or require participants to bear more than nominal financial risk for losses. Physicians who participate in qualified Alternative Payment Models are exempt from MIPS and can earn a 5% annual incentive payment.