CMS Quality Payment Program

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is one of the most significant changes in healthcare reimbursement in the past few decades.

Apollo HIT has invested heavily in understanding the nuances of MACRA and is actively providing assistance to practices.

Below are examples of how we may be able to provide assistance:

Understand the options available to practices regarding MIPS and APMs. The majority of providers will be under MIPS in 2017, however, CMS has adjusted the reporting requirements for 2017 in ways that it may make it easier to achieve higher positive payment adjustments. CMS recommends that practices that are engaged in advanced APMs still consider themselves as being in the MIPS, as APM status determinations will not be made until 2018.

Selecting the duration of a MIPS reporting period. Choosing the right period of time to report will give your practice the best chance of achieving higher performance, including payments for exceptional performance.
MIPS group reporting options: There are numerous considerations when selecting reporting options as individuals or groups. Group reporting has advantages and disadvantages depending on the practice size and sub-specialty mix. The need to be able to aggregate data for reporting may also creates challenges for some practices.

Reporting mechanisms: there are several options for reporting including claims based reporting, qualified registries, qualified clinical data registries, EHRs, and the CMS Web Interface. Each reporting mechanism has its own considerations and requirements.
Attaining the highest possible scores in the quality performance category: CMS will choose the six measures that are reported that have the highest performance rates. We have had success assisting practices with attaining very high performance rates for PQRS, which is similar in many ways to MIPS quality reporting. We can demonstrate provider friendly and highly efficient mechanisms for capturing quality measure data within your EHR.

Strategies to attain the MIPS additional positive payment adjustment. A pool of $500 million has been set aside for each of the first six years of the MIPS program. CMS has been directed to spend all of these funds each year. The additional payment can reach its highest 10%, and is in addition to the “standard”positive payment adjustment under MIPS. In 2017 the threshold for receiving the additional adjustment has been established at 70 points. Practices that achieve above 70 points will receive additional payments in 2019. We will help you determine thresholds under each MIPS performance category that will need to be met in order for you to attain additional payment adjustments for exceptional performance.

Please see MACRA University for additional information on MACRA.