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Jeff Jones, CPHP

Jeff is a Certified PQRS Healthcare Professional (CPHP) and a regular contributor to GroupOne's blog on the topic of Quality Payment Programs and MACRA legislation.

Email: jjones@g1hs.com

Author's Posts

MACRA: New Opportunites for Medicare Providers with Alternative Payment Models

by Jeff Jones, CPHP on May 26, 2016

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. 14th, 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.

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Topics: Value-Based Reimbursement, Incentive Programs, MACRA, Alternative Payment Models

What You Need to Know About the MACRA NPRM

by Jeff Jones, CPHP on May 25, 2016

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.

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Topics: Revenue Cycle Management, CMS, Merit Based Incentive Payment System, Incentive Programs

A Simple Guide to Understanding PQRS Measures and Specifications

by Jeff Jones, CPHP on May 19, 2016

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.

 

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Topics: PQRS, Incentive Programs

The Value-Based Payment Modifier Program and It's Impact on Your Practice

by Jeff Jones, CPHP on May 4, 2016

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.

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Topics: PQRS, Value-Based Reimbursement, Incentive Programs

Selecting the Right PQRS Measures: Individual vs. Measures Groups

by Jeff Jones, CPHP on May 2, 2016

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.

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Topics: PQRS, Incentive Programs

Everything You Need to Know About PQRS Reporting Methods

by Jeff Jones, CPHP on April 15, 2016

As we shift the focus from volume and profitability to patient outcomes, physicians are having to dig a litter deeper into reporting. Healthcare is shifting towards value-based reimbursement models and the Physician Quality Reporting System (PQRS) is a step in that direction. Unfortunately, at first glance, PQRS and CQM programs can be intimidating to say the least. Not only can PQRS be intimidating, but a large number of physicians believe that PQRS is time-consuming. PQRS participation rates reflect the number of providers that aren't making PQRS a priority. 

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Topics: PQRS, Incentive Programs

Understanding PQRS: What It Is and What You Need to Know Now

by Jeff Jones, CPHP on April 12, 2016

You could say Meaningful Use stole the spotlight from PQRS over the past couple of years. This could be why so many providers still have questions about the Physician Quality Reporting System. With the Merit Based Incentive Payment System (MIPS) just around the corner, PQRS isn't quite in the spotlight but it does play an important role in physician reimbursement. Now is the time to begin understanding PQRS (if you don't already) and how it will contribute to MIPS.

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Topics: PQRS, Incentive Programs

Should You Be Participating In PQRS?

by Jeff Jones, CPHP on March 29, 2016


For the first few years of PQRS, practices were eligible for incentive payments for PQRS reporting. In 2015, however, EPs that did not report on specific quality measures are facing downward adjustments to Medicare payments in 2017. Here's how you know whether you should be participating in PQRS (if you aren't already).
 

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Topics: PQRS, Incentive Programs

Is Your Brand at Risk? How MIPS Can Impact Physician Brand

by Jeff Jones, CPHP on February 23, 2016

In our previous blog post, How MIPS Affects Physician Reimbursement, we introduced the topic of how MIPS will highlight a clinician’s brand and could possibly affect the amount of patients a clinician sees. This blog post dives deeper into this concept and explores what you can do to begin attacking MIPS now in order to establish a positive brand and start accepting new patients.

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Topics: Merit Based Incentive Payment System, Incentive Programs

6 FAQs About the Merit Based Incentive Payment System

by Jeff Jones, CPHP on February 18, 2016

In April 2015, both Congress and President Obama approved a bill called the Medicare Access and CHIP Reauthorization Act (MACRA), a significant, bipartisan bill that repealed the Medicare Part B SGR reimbursement formula and replaced it with a pay-per-performance program. This new program is called the Merit-Based Incentive Payment System (MIPS) and it is changing provider reimbursement.

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Topics: Merit Based Incentive Payment System, Incentive Programs

How MIPS Affects Physician Reimbursement

by Jeff Jones, CPHP on February 9, 2016

Declining reimbursement is one of the greatest financial challenges physicians face today. While there isn't much you can do to stop reimbursement cuts, you can be proactive in learning about the Merit Based Incentive Payment System and how it will impact physician reimbursement.

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Topics: Merit Based Incentive Payment System, Incentive Programs

The Merit-Based Incentive Program: What You Need to Know

by Jeff Jones, CPHP on January 27, 2016

The healthcare industry has unveiled another addition to the already enormous alphabet soup. This new addition goes by the name MIPS, or more properly, Merit-based Incentive Payment System and it is quickly moving healthcare provider towards value-based reimbursement. Here's how.

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Topics: Merit Based Incentive Payment System, Incentive Programs

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