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Cover Story: MACRA –

Is Your Medical Practice Poised for Success?

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Quick Participation Preferred: ting data through your electronic health record (EHR) or a
The QPP which is in its 3rd performance year and 1st payment Registry/Qualified Clinical Data Registry (QCDR), abide by your
adjustment year has two tracks: Merit-Based Incentive Payment internal submission dates.
System (MIPS) and the Alternative Payment Model (APM).
MIPS payment adjustments are based on your performance on What the Future Holds
the measure and activity data you collect and submit for four The current full performance period is January – December 31,
MIPS performance categories: Quality , Improvement Activities, 2019, but not all categories require 12 months of data collection.
Promoting Interoperability (through the use of certified EHR Payment adjustments based on this performance period will be
technology) and Cost. Each category is worth a certain percent- made in 2021. By law , this program must be administered and
age and within it, each measure carries points. After taking into though it may be modified from year to year, it is here to stay . The
account the set minimum threshold, the final cumulative score is program continues to evolve given the underlying pressure to
used to determine whether you receive a positive, neutral, or neg- drive value over volume, and identify meaningful patient out-
ative payment adjustment on your Medicare Physician Fee comes while reducing the burden on providers.
Schedule (PFS) and Medicare Part B allowed charges. Since QPP
must remain budget neutral, the amount by which a positive Success Is Paramount
MIPS payment adjustment factor is increased or decreased Success with QPP really hinges on the basics of proper plan-
depends on the distribution of final scores across all MIPS-eligible ning and monitoring. First, visit the CMS- QPP website to deter-
clinicians. mine participation eligibility and the measure requirements for
APM gives added incentive payments to provide high-quality your practice. Set up the reporting mechanisms and reports –
and cost-efficient care by way of bonus payments for participation technology is vital for this. Review your performance against set
in an eligible alternative payment models (APMs) such as the var- goals on a monthly basis, and make indicated improvements
ious ACOs, bundling, and shared savings programs. CMS deter- accordingly . Ensure that you manage activities to all deadlines.
mines the qualifying APM participants (QPs). There are many ways for medical practices to get assistance
To check your eligibility for participation by performance year, with facilitating a successful implementation of QPP . Practice
use the QPP participation status tool that can be found on the transformation consultants are available to assist with the full
CMS – QPP website by entering your 10-digit National Provider implementation of the program in your respective practices and,
Identifier (NPI) number to find out about your requirement to direct technical assistance are available on the CMS-QPP website.
participate or even if you can opt-in. Success in the MACRA-legislated QPP program is now a key
The submission window for the performance year in 2018 is business imperative for healthcare providers. For information
open through April 2, 2019. CMS web interface users need to about the QPP program, visit the CMS website at
report their quality performance category data by March 22, https://qpp.cms.gov/
2019. If you are a clinician/practice that reported quality meas-
ures via Medicare Part B claims throughout the 2018 performance Oyinkansola Ogunrinde is the Founder and Chief Practice
year, CMS receives your quality data from claims processed by Transformation Officer of FUNMI Healthcare Consulting, LLC, a
your Medicare Administrative Contractor (MAC). Claims for consultancy specializing in the management of physician practice
services provided during 2018 must be processed within 60 days and ambulatory services (www.funmihc.com). She can be reached at
after the end of the 2018 performance period. If you are submit- bukky@funmihc.com and (561) 320-1071.

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6 March 2019 southfloridahospitalnews.com South Florida Hospital News