Category Archives: Articles Authored by Apollo HIT Staff

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Quality Payment Program 2020: Changes and Requirements (Part II)

Part II of the five-part series on the Quality Payment Program in 2020 authored by Michael Stearns, MD, CPC, CRC, CFPC, founder and CEO of Apollo HIT, LLC, has been published.  It is available here.

This article addresses the requirements for the quality performance category of the the Merit-based Payment Incentive System (MIPS) in 2020.


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Quality Payment Program 2020 Updates and Requirements (Part I)

Posted February 5, 2020

The Journal of the American Health Information Management Association (JAHIMA) published an article titled Quality Payment Program: 2020 Changes and Requirements Part 1, the first of a five-part series on the Quality Payment Program for 2020.  The article was authored by Michael Stearns, MD, CPC, CRC, CFPC, founder and CEO of Apollo HIT, LLC. Dr. Stearns has served as a principal author for JAHIMA on articles related to the QPP.

Part I of this series provides background on the MIPS and quick reference tables that identify key requirements for 2020, contrasted with the requirements for 2019.


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MIPS APMs and How They May Impact Your MACRA Strategy

This article was published in the September 2017 addition of the Journal of AHIMA and became available online in August 2017.

A large number of MACRA professionals have reported that many providers are enrolled in an aspect of the MACRA Quality Payment Program called MIPS APMs without their awareness. Providers who agreed to participate in Track 1 Accountable Care Organizations 2017, for example, and to otherwise meet the MIPS eligibility criteria are in MIPS APMs. Via a direct communication with CMS clinicians cannot elect out of the MIPS APM.

MIPS APMs have advantages but also potential disadvantages. All participants will receive the same MIPS score. The most common example would be a Track 1 ACO. In this model all providers will have their MIPS score determined based on the ACO’s performance on the ACO quality performance measures and  each individual practice’s Advancing Care Information performance.  One of the benefits of participating in a MIPS APM is that in most instances Medicare will automatically credit all participants with the maximum 15 points in the Improvement Activity performance category.

However, specialists who may be participating in ACO will not have much influence over the majority of the quality measures used to determine performance. If the ACO is performing well on the quality measures the practice may be eligible for a relatively high MIPS score. This will depend in part on how well they perform in the Advancing Care Information category.  CMS will use a weighted average of ACI scores across the entire eligible ACO membership population of clinicians to determine a composite ACI score for the MIPS APM entity, i.e. the ACO.

This article discusses a number of considerations related to MIPS APMs that are not widely known in healthcare community.

The article was co-authored by Susan R. Bradshaw, MS, MBA, RHIA; Donald G. Krause, MBA, CPA; and Michael Marron-Stearns, MD, CPC, CFPC.  Dr. Marron-Stearns is the CEO and founder of Apollo HIT, LLC.

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Article citation:
Bradshaw, Susan R; Krause, Donald G; Marron-Stearns, Michael. “MIPS APMs and How They May Impact Your MACRA Strategy” Journal of AHIMA 88, no.9 (September 2017): 22-25.


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Embrace the MIPS Additional Payment Adjustment for Exceptional Performance

This article discusses the Additional Positive Payment Adjustment for exceptional performance under MIPS. The article requires membership to AHIMA however for reprints please reach out to us at

in summary, the article discusses the $500 million fund available annually for the first six years of the MIPS program. These funds are used to reward high performing clinicians with additional positive payment adjustments that can reach as high as 10%.  In 2017 practices that reach 70 or more MIPS points are eligible for this additional payment adjustment. Practices that score near 100 points may be eligible for of up to a 10% positive payment adjustment in addition to the baseline positive payment adjustment.

Because Medicare artificially establish the performance threshold for MIPS at three points there will be relatively little funds available from practices that receive negative payment adjustments to fun positive payment adjustments. It is estimated that a near perfect score under MIPS will not result in more than a 1 to 2% positive payment adjustment from the base score. This makes the additional payment adjustment the most likely way practices can earn significant returns on investment for MIPS based on performance in 2017 and 2018.

Practices that achieve a MIPS score of 85 points in 2017 may see a positive payment adjustment of between 5% and 6% for all part B payments in 2019.

Practices and large healthcare organizations should take the additional payment adjustment for exceptional performance into strong consideration when determining their MIPS strategy and goals.

This article was authored by Michael Marron-Stearns, MD, CPC, CFPC, the CEO and founder of Apollo HIT, LLC.  For reprints of this article please reach out to us at

Article citation:
Marron-Stearns, Michael. “Embrace the MIPS Additional Payment Adjustment for Exceptional Performance” Journal of AHIMA 88, no.6 (June 2017): 30-33.

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How MACRA Changes Health Information Management (HIM)

This article was published in March of 2017 and identifies how health information management (HIM) professionals, including administrators, clinical documentation integrity specialists, compliance specialists, coding specialists, coordination of care specialists, informaticists, and those engaged and related services play an essential role in organizational performance under the Quality Payment Program (MACRA).

It identifies the key roles of HIM professionals in helping organizations achieve optimal success in the key performance categories under MIPS including Quality, Advancing Care Information, Improvement Activities, and in the near future Cost.

The article also reviews the role of HIM professionals and Advanced Alternative Payment Models such as shared risk ACO’s.

The article was authored by Michael Marron-Stearns, MD, CPC, CFPC, the CEO and founder of Apollo HIT, LLC

Article citation:
Marron-Stearns, Michael. “How MACRA Changes HIM” Journal of AHIMA 88, no.3 (March 2017): 22-25.

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MACRA, MIPS, and Advanced APMs: Time to Prepare (Published Article)

This article discusses how to prepare for the Quality Payment Program (MACRA).   It was written in June of 2016 in advance of the 2017 Final Rule for the QPP and a number of items were changed in the final rule.

It was authored by Michael Marron-Stearns, MD, CPC, CFPC, the CEO and founder of Apollo HIT, LLC

See also MACRA University for additional and updated information related to MACRA.


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