The latest in CMS news, particularly surrounding MACRA, is the availability of the new Qualifying APM Participant Look-Up Tool. Who has qualified so far and will be excluded from the MIPS track of MACRA?
The Centers for Medicare and Medicaid Services (CMS) announced the results of the first Qualifying APM Participant (QP) determinations based on eligible clinician participation in the 2017 Advanced Alternative Payment Models (APMs). CMS offers a new interactive look-up tool where many 2017 Advanced APM participants can look up their QP status, which was determined based on calculations from claims with dates of services between 1/1/17 and 3/31/17 for the first QP snapshot.
Advanced APMs and the Quality Payment Program
Eligible clinicians who meet certain criteria are considered QPs in Advanced APMs under the Quality Payment Program. This means they are excluded from reporting through the Merit-Based Incentive Payment System (MIPS) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). According to CMS news, “QPs identified based on the 2017 performance year will receive a 5 percent lump sum Medicare incentive payment in 2019.”
What is the Quality Payment Program?
From CMS news featured on the Quality Payment Program website:
If you participate in Medicare Part B, you are part of the dedicated team of clinicians who serve more than 55 million of the country’s most vulnerable Americans, and the Quality Payment Program will provide new tools and resources to help you give your patients the best possible care. You can choose how you want to participate based on your practice size, specialty, location, or patient population.
The Quality Payment Program has two tracks you can choose:
- Advanced Alternative Payment Models (APMs) or
- The Merit-based Incentive Payment System (MIPS)
If you decide to participate in an Advanced APM, through Medicare Part B you may earn an incentive payment for participating in an innovative payment model.
If you decide to participate in MIPS, you will earn a performance-based payment adjustment.
CMS plans to update the interactive look-up tool soon with calculations from claims with dates of services between 1/1/17 and 6/30/17.
CMS offers a Methodology Fact Sheet that explains how QP status is determined, and its supplemental service payments fact sheet describes the supplemental service payments included in its APM Incentive Payment calculations.
“Game Changer: Preparing for Success With MACRA” will be a valuable tool in helping you understand the intricacies of the Quality Payment Program, the differences between the MIPS and Advanced APM tracks, and how implementing a Chronic Care Management program and other care coordination services from CareSync can help you succeed under MACRA.
To learn more, contact email@example.com or call CareSync at 1-800-501-2984.