ACO ReportingAlternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)PQRS ReportingValue-Based Health Care
May 31, 2016

Your MACRA Prep for APMs: Learn from ACO Failures

Many provider groups are suddenly realizing they need to understand how a Medicare risk model will impact their operations and revenues. With CMS pushing providers to embrace Alternative Payment Model (APM) risk models under Proposed MACRA Rules, they should be nervous. Although prior APMs such as ACOs did not approach the levels of risk under MACRA (most had zero risk in the first year), most were unsuccessful in reaching targeted savings. Lessons learned from ACOs will help groups make better decisions about how to manage costs, performance improvement, referrals outside the network and provider recruitment. Here are some key posts…
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Merit-Based Incentive Payment System (MIPS)PQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Payment Modifier
May 24, 2016

Large Practice PQRS Reporting: Act Now Before GPRO Self-Nomination Deadline

If you’re still on the fence about reporting PQRS as a Group or Individual for 2016, it’s decision time. With the June 30 deadline for Group Reporting self-nomination just over a month away, you need to check out your options now or risk expensive reporting failures. These are your choices: Report for providers individually, which means that at least 50 percent of eligible professionals billing under one TIN must successfully meet PQRS reporting criteria; Report for providers using a Group Reporting Option (GRPO) in one of three ways: a. GPRO Registry option, by which you select a Registry to perform…
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Alternative Payment Models (APM)Clinical IntegrationFuture of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
May 17, 2016

3 Ways Proposed MACRA Rules Revive Health Systems’ Clinical Integration Programs

Clinical Integration in medium to large Health Systems just received a nice push from the federal government’s Proposed Rules for MACRA. Health Systems trying to market quality-based physician and hospital networks systems— especially those with both employed and private physicians—should take note. This opportunity for Health Systems to bridge Medicare and private health plan quality is one of the best features of MACRA. Why? Look at this triple play of provisions woven through both MIPS and APMs: “Other-Payer” Advanced APMs will be allowed in the program’s third year to meet Advanced APM status by participating in both Health Plan and Medicare…
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Alternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Health Care
May 10, 2016

Proposed MACRA Rules Boost QCDR Development

One of the promises fulfilled by the new Proposed MACRA Rules, released April 27, is to position the Qualified Clinical Data Registry (QCDR) front and center. In fact, the Rules place the QCDR on par with the EHR in the spectrum of Health Care Information Technology (HIT) and give it special emphasis in Performance Improvement. Yet the QCDR is mysterious to most providers. While providers and heath systems try to sort through all of MACRA recalculations for provider gain or loss under the new Quality Payment Programs, it can be easy to miss the simultaneous revolution in HIT to support…
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Alternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
May 3, 2016

Know the F.A.C.T.S.: 2016 Proposed MACRA Rule Highlights

Just over a year since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed, the new Proposed MACRA Rule was released on April 27. Now we finally have some details on how Fee For Service will yield to reimbursement through value. There’s a lot to digest in this hefty rule and a great deal at stake, including hundreds of millions of dollars in penalties and incentives. Here’s what you need to know about the proposal and how it affects you. And if you have concerns, be sure to speak up during the 60-day comment period! As anticipated, Alternative…
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