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Practice Transformation

Practice Transformation Advisors in Hackensack, New Jersey

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Practice Transformation

A promise to fundamentally change the way of evaluating and paying for health care was signed into law on April 16, 2015 with a bipartisan legislation called Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

What does MACRA do?

  • Repeals the Sustainable Growth Rate (SGR) Formula
  • Changes the way that Medicare rewards clinicians for value over volume
  • Streamlines multiple quality programs under the new Merit-Based Incentive Payments System (MIPS)
  • Provides bonus payments for participation in eligible alternative payment models (APMs)

The Merit Based Incentive Payments System (MIPS) integrates parts of the Medicare Electronic Health Record (EHR), the Value Modifier (VM or Value-Based Payment Modifier), and the Physician Quality Reporting System (PQRS) incentive programs into one. Under MIPS, Eligible Professionals (EPs) will be measured and paid based on:

  • Quality
  • Resource Use
  • Clinical Practice Improvement
  • Advanced Care Information

Alternative Payment Models (APMs) provide a new way for Medicare to compensate healthcare providers for the support they give to Medicare beneficiaries. Most providers who take part in APMs will also be subjected to MIPS but will receive favorable scoring – with correspondingly higher reimbursement rates. Providers participating in the most advanced APMs may be designated as Qualifying APM Participants (QPs), which are not subject to MIPS. They may be eligible for:

  • Annual 5% lump-sum bonus payments from 2019 through 2024;
  • Beginning in 2026, higher annual premiums (for some participating providers); and
  • Increased flexibility through physician-focused payment models

Quality

  • Reduces reporting burden
  • Reduces administrative claims measures
  • Reduces data completeness criteria
  • Reduces reporting thresholds
  • Increases quality percent of composite performance score
  • Encourages the use of QCDRs and electronic sources

Resource Use

  • Reduces weight of composite performance 2
  • Phases in episode-based measures
  • Retains two problematic cost measures currently used in the value modifier
  • Tools to improve cost measurement are under development

Clinical Practice Improvement

  • Reduces reporting burden
  • Provides accommodations for small, rural, health professional shortage areas (HPSAs) and non-patient facing physicians
  • Finalizes 90-day reporting period
  • Increases number of highly-weighted activities
  • Expands definition of medical homes eligible for full Improvement Activity credit
  • Provides full credit for MIPS APMs
  • Incentivizes use of certified electronic health record technology (CEHRT)

Advancing Care Information

  • Reduces reporting burden
  • Temporarily shortens reporting period
  • Promotes coordination between performance categories
  • Eliminates measures
  • Retains a pass-fail element

Maximize the services offered by our care specialists to assist your practice in applying the Quality Payment Program.

In order for providers to optimize payments under Advanced APMs and MIPS, eligible professionals should focus their efforts on these three (3) areas immediately:

  • Annual Wellness Visit Programs

    The Annual Wellness Visit (AWV) is a preventive benefit available offered to anyone with Medicare
    Part B to stay healthy and productive.

    The Medicare Annual Wellness Visit (AWV) identifies high-risk over-utilizers, provides powerful tools to support patient wellness, and offers a valuable new revenue source. Working closely with hospitals, PHOs, ACOs, clinics, and physicians, Phoenix Healthcare Advisors has developed a comprehensive solution that enables hospitals and their primary physicians to benefit whether in a short-term or long-term.

  • Chronic Care Management Program

    MACRA’s essential component is the proactive and frequent care management of patients with multiple chronic conditions provided under Chronic Care Management (CCM).

    CCM is the non-face-to-face services provided to Medicare beneficiaries who have two or more significant chronic conditions. In addition to office visits and other face-to-face encounters (billed separately), these services include communication with the patient and other treating health professionals for care coordination (both electronically and by phone), medication management, and being accessible 24 hours a day to patients and any care providers (physicians or other clinical staff).

    The creation and revision of electronic care plans are also a key component of CCM.

  • Transitional Care Management

    Transitional care management (TCM) provides the supervision and coordination of health care services for patients transitioning from an inpatient hospital to community setting. Qualified providers are encouraged to provide the necessary resources and administration to help prevent patients from being readmitted.

Let Us Know How We Can Successfully Help You in Participating in the Quality Payment Program (QPP). Reach Us Today!

Contact Information

277 Prospect AvenueHackensack, New Jersey

855-544-0475

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