Understanding the CMS Proposed Rule for the Medicare Access and CHIP Reauthorization (MACRA) and Alternative Payment Model (APM’s)

After reviewing the Merit-based Payment System (MIPS) in detail, we now focus our attention on the alternative payment model (APM) track of the new Quality Payment Program. This stems from the Centers for Medicare and Medicaid Services' (CMS) recently proposed rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA). Advanced APMs Beginning in 2019, eligible clinicians who participate in Advanced APMs may become qualifying participants (QPs) each year by meeting certain thresholds; upon becoming QPs, they are excluded from the MIPS program for any years in which they qualify as QPs. For 2019 and 2020, eligible clinicians may become QPs only by participating in Advanced APMs; Medicare is the payer for all Advanced APMs. For 2021 and beyond, eligible clinicians may continue to become QPs by participating solely in Advanced APMs, but they also can achieve QP status by participating in a combination of Advanced APMs and APMs with other payers (Other Payer Advanced APMs). For 2019 through 2024, while the Medicare annual physician fee schedule (PFS) conversion factor update is zero (0.0%) for QPs and for MIPS clinicians, each QP receives a lump sum incentive payment (5 percent of the QP's prior year Part B covered professional services payments). Starting in 2026, the PFS annual update will be set higher for QPs (0.75%) than for eligible clinicians who are not QPs. A tremendous article that breaks down the specific requirements of Advanced APMs can be found he...
Source: Policy and Medicine - Category: American Health Authors: Source Type: blogs