Roji Intel Blog

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Alternative Payment Models (APM)MACRAPerformance ImprovementValue-Based Health Care
September 20, 2016

MACRA APM Risk: 5 Keys for Redefining Performance Improvement

Whatever relief providers felt after the recent CMS MACRA Pick Your Pace announcement, don’t be fooled. CMS has not, it seems, backed off its goals of pushing providers toward Risk, nor the interim and final quotas for participation. To the contrary—the announcement pointedly suggested that providers consider joining a risk-based Alternative Payment Model (APM) in 2017. But here’s the bigger issue: most existing ACOs have failed to meet cost targets, and the risk of losses for risk-based APMs will fall back on the participating providers. MACRA Pick your Pace should not be a time of rest. You should run, not…
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Future of Health CareMACRAMeaningful UsePerformance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health Care
September 13, 2016

CMS Okays MACRA Flexibility: Standstill or Startup for Providers?

With the CMS announcement last week that the final MACRA Rules will let providers pick and choose activities—or even delay requirements—2017 implementation is now a toss-up. Will providers double down on efforts to meet the MACRA standards in 2018? Or, will eased deadline pressure reverse momentum within health care systems? There are many valid reasons why the lead-time decision is important. MACRA represents one of the biggest overhauls of the Medicare reimbursement program, and many of the elements have not been fleshed out. Releasing final rules one month in advance of their going into effect surely makes it difficult for…
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ACO ReportingAlternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry Reporting
August 23, 2016

ACO Under MACRA? Five Essential Takeaways

While Accountable Care Organizations (ACOs) get a little boost under proposed MACRA Rules, this comes at a price. MACRA provides a 5 percent bonus and a MIPS reporting exemption for providers who participate in an Advanced Alternative Payment Models, the most common being a Stage 2 or 3 ACO—if and only if they assume a minimum requirement for risk. The deal is this: CMS wants providers to move toward Alternative Payment Plans with greater financial risk by living under the equivalent of a budget for their patients’ health care. That concept, which imposes downstream risk to physicians if the budget…
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Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
August 2, 2016

Use PQRS 2016 Reporting to Prepare for MACRA MIPS

In the last year of PQRS reporting, you may be tempted to take it easy and complete the bare minimum of reporting requirements. But don’t stick your head in the sand. First, PQRS and Value Modifier (VM) penalties are still alive and strong in 2016 and will affect your revenues in 2018. Second, if you’ve only been meeting reporting requirements and have yet to evaluate your performance, you stand to lose more under the tougher requirements of MACRA MIPS next year. We cannot stress this enough: 2016 should be the year to seriously evaluate your performance and create your strategy.…
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ACO ReportingAlternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementQualified Clinical Data Registry ReportingValue-Based Health Care
July 12, 2016

MIPS v APM: Which Is Your Best Bet?

If you’ve been watching the signals from CMS, you undoubtedly know by now that the current reimbursement structure under Medicare will end, to be replaced by a Quality Payment Program (QPP) that holds providers at risk for resource use and quality. The ensuing choices, however, are confusing. Providers can select one of two QPP tracks: Continue Fee for Service (FFS) and fall under the Merit Incentive Payment System (MIPS) or participate in an Alternative Payment Model (APM), such as a risk-based ACO. So, how do you know if MIPS or APM is the best way to go, and on what…
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Alternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Health Care
July 5, 2016

Succeed Under MACRA Medicare: How to Meet CPIAs for Full Credit in MIPS

Although many parts of MACRA’s MIPS continue Medicare’s existing quality programs, Clinical Performance Improvement Activities (CPIAs) forge a new direction. CPIAs are one of four MIPS components that practices must meet in order to obtain full reimbursement from Medicare. Forward planning is essential. It takes time to strategize and implement performance improvements, including partnerships and technology. To make this happen in 2017—the base year for performance measurement—providers must prepare before the MACRA rules are finalized. CPIAs are a unique sign of Medicare’s intent to hold practices accountable for improving health care outcomes. That’s a significant step in Medicare’s evolving role…
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Alternative Payment Models (APM)MACRAMeaningful UseMerit-Based Incentive Payment System (MIPS)PQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
June 21, 2016

MACRA Medicare: Customize MIPS Strategy to Your Practice’s Attributes

Under MACRA Medicare’s Proposed Rules, CMS anticipates that as many as 90 percent of providers will be part of MIPS’s first year, beginning January 1, 2017. That includes providers in ACOs that don’t bear enough risk for exemption, providers who reported PQRS and Meaningful Use, as well as those who did nothing, “waiting out” Medicare’s plans. Not only is the wait over, but only about half a year remains until MIPS begins. And the challenges won’t fall evenly across provider groups. Size, specialty and support will weigh heavily into MIPS success. A customized MIPS strategy is your key to avoiding the…
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ACO ReportingAlternative Payment Models (APM)Future of Health CareMACRAMeaningful UseMerit-Based Incentive Payment System (MIPS)Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health Care
June 7, 2016

Proposed MACRA Rules: Your APM Strategy for Risk Readiness

If you chose not to participate in Medicare ACOs or Bundled Payments in recent years, CMS is planning to change your mind. Proposed MACRA Rules reveal a complex carrot-and-stick approach to inducing providers into risk models. Make no mistake: it’s just a matter of when, not if, you participate in one of the Alternative Payment Models (APMs). It will pay (literally) to begin planning your path to risk now. Here are five important provisions in the Proposed Rules that you need to understand: Full qualification as an Advanced APM earns a 5 percent lump sum bonus, exemption from participation in…
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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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