Are you eligible for MIPS? With 2017 being the first performance year, it's imperative that you know how the Merit-based Incentive Payment System could affect your revenue cycle management.  We put together a cheat sheet to help you understand your participation options with MIPS in 2017 and the financial impact it could have on your revenue cycle in the coming years.

As of January 1, 2017, the first performance period for the new Merit-based Incentive Payment System (MIPS) is officially underway for eligible physicians. The new payment system aims to change how physician services are paid by moving away from fee-for-service payments to performance-based payment adjustments. Depending on the data you submit by March 31, 2018, your 2019 Medicare payments could be adjusted up, down, or not at all.

Worried about participating in the Merit-based Incentive Payment System? CMS is conducting a Clinical Practice Improvement Activities (CPIA) Study that can help you meet the CPIA requirement. Individual clinicians and groups who are eligible for MIPS that participate successfully in the study will receive full credit for the Improvement Activities performance category. Applications for the study will be accepted from January 1 – 31, 2017.

When it comes to government regulations and health care, change is inevitable. In contrast to the current fee-for-service care, the value-based care model aims to compensate physicians for high-quality service, clinical performance, and patient satisfaction. It's an exciting time for the future of healthcare, and small practices are uniquely situated to thrive in the transition to value-based care.

With 2017 upon us, many practices are scrambling to understand the Quality Payment Program final rule. The final rule was published on October 14, 2016 with CMS making significant revisions to the proposed rule. In the final rule, CMS increased the flexibility of the Medicare Access and CHIP Reauthorization Act (MACRA) by introducing an option-based implementation plan, titled “Pick Your Pace,” which allows providers to ease into MACRA for the 2017 reporting year.

The Centers for Medicare and Medicaid Services (CMS) has recently released new quality data on the Physician Compare website, which includes 2015 Physician Quality Reporting System (PQRS) performance scores for group practices, individual physicians and other clinicians, and Accountable Care Organizations (ACOs), as well as non-PQRS Qualified Clinical Data Registry (QCDR) data for individual clinicians. Here's what this means to your practice.

The final rule on MACRA was released by the Department of Health and Human Services on October 14^th, 2016. Since the final rule weighs in at a staggering 2,171 pages, we here at GroupOne thought it would be helpful to provide you with a list of resources that offer detailed information about the final rule.

The Department of Health & Human Services (HHS) finalized a landmark new payment system for Medicare clinicians that will continue the Administration’s progress in reforming how the health care system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR), will equip clinicians with the tools and flexibility to provide high-quality, patient-centered care.

The Merit-based Incentive Payment System (MIPS) is coming in 2019, and this new physician payment policy is undoubtedly going to be a game-changer. Although it's still a few years out, it's important for healthcare professionals to develop a thorough understanding of how the Merit Based Incentive Payment System and MACRA in general will impact physician reimbursement and medical practice operations.

On September 8^th, Acting Administrator of CMS Andy Slavitt announced four MACRA implementation tracks that will allow eligible clinicians to pace their own transition and participation in the program. Eligible clinicians will be able to select their own pace for MACRA attestation to ensure all participants can succeed under new value-based reimbursement programs, CMS announced.

In April we published a post announcing the launch of the new risk-based primary care initiative, Comprehensive Primary Care Plus (CPC+). Now, we are nearly just one week away from applications for CPC+ being due. So what should you know before submitting your application? We've compiled a list of frequently asked questions about the CPC+ program and some answers to help you better understand it.

We welcomed the news earlier this year that the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) released a Notice of Proposed Rulemaking (NPRM) to allow for flexibility in meeting Meaningful Use this year. However, the 90-day reporting period for 2016 still has not been finalized and the final 90-day reporting period in calendar year 2016 is rapidly approaching.

Encouraging physicians to switch to electronic health records (EHR) has been a long term effort from CMS ever since the January 2009 passage of the HITECH act. Over three-quarters of physicians and nearly all hospitals are using an EHR but the incentivizing structure has been hard to wade through, at best. Now healthcare professionals and physicians alike must focus their efforts on understanding the end of the SGR formula and the beginning of The Merit Based Incentive Payment System and Alternative Payment Models.

Some interesting discussions have emerged since the MACRA proposed rule was announced. One that is acquiring a lot of attention is the eligibility requirements of Advanced APM entities. Under the proposed rule only Advanced APMs will qualify for the 5% annual lump sum payment and be exempt from MIPS. In this post we will dive deeper into what it takes to become an Advanced APM and what happens if an APM entity does not qualify as an Advanced APM.

The MACRA final rule details how Alternative Payment Models (APM) will enhance or replace some of the current fee-for-service payments. While the criterion may seem simple in theory, additional details help clarigy the difference between an Advanced Alternative Payment Model and an Alternative Payment Model.

With the repeal of Medicare's sustainable growth rate formula also came the opportunity for physicians to eventually leave the traditional Medicare fee-for-service system behind. The shift from fee-for-service to value based reimbursement is a new opportunity for physicians but with it comes some challenges in understanding how it will work. The final rule, released on Oct. 14^th, details how Alternative Payment Models (APM) will enhance or replace some of the current fee-for-service payments with a patient-level payment not related to volume or intensity.

The Centers for Medicare and Medicaid have released the notice of proposed rule-making (NPRM) for the Medicare Access and CHIP Reauthorization Act. The proposed rule was released in late April and the final rule is schedule to be released in the fall of this year (2016). Here is a breakdown of the MACRA NPRM if you haven't yet had the time to read the entire 962 pages.

In 2016, providers are able to select from a large number of measures to submit PQRS data. However, understanding PQRS measures and specifications can be overwhelming. And since the measures you choose have a large impact on your quality and cost scores, deciding on the right measures to report should not be taken lightly. Here we will guide you through how to better understand PQRS measures and the specifications for measures.

The Value-based Modifier (VBM) provides for differential payments to a physician or group of physicians under the Medicare Physician Fee Schedule and is based upon the quality of care furnished compared to cost during a performance period. The Value Modifier program will provide comparative performance information to physicians as part of Medicare’s effort to improve the quality and efficiency of medical care. Here is how the Value Modifier program relates to PQRS and MIPS to further the movement from fee-for-service to value-based reimbursement.

Taking time to select the right PQRS measures can make a huge difference in an Eligible Providers (EP) performance in PQRS. How? Because choosing PQRS measures that align with your specialty usually makes it easier to report for the PQRS. Therefore the measure selection process should begin with a review of the entire measure list to determine which measures are important to the EP and the practice.