Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

MACRA Implementation

MIPS Participation Reached 95% in 2017, Exceeding CMS Goals

March 21, 2019 - Ninety-five percent of eligible clinicians avoided a negative payment adjustment through Merit-Based Incentive Payment System (MIPS) participation in 2017, of which 93 percent earned a positive adjustment. The findings come from the 2017 Quality Payment Program Reporting Experience report recently published by CMS. The report provides a comprehensive view of the clinician experience in...


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AMGA: Full MACRA Implementation Needed to Advance Value-Based Care

by Jacqueline LaPointe

AMGA is urging Congress to enforce MACRA implementation as policymakers intended by no longer excluding providers from the Merit-Based Payment Incentive Program (MIPS). “MIPS was designed as a viable transition tool to value-based...

HHS Sets New Priorities for Physician-Focused Payment Models

by Jacqueline LaPointe

Healthcare stakeholders looking to develop their own alternative payment models for HHS implementation should look to new guidance before submitting their applications to the Physician-Focused Payment Model Technical Advisory Committee...

Rural, Small Practice MIPS Performance Lagged Behind Large Peers

by Jacqueline LaPointe

Rural and small practices fared worse than their large peers in MACRA’s Merit-Based Incentive Payment System (MIPS) in 2017, new research shows. Nearly one in five small practices received a negative MIPS payment adjustment compared...

5% of MIPS Eligible Clinicians Earn a Negative Payment Adjustment

by Jacqueline LaPointe

Approximately 93 percent of eligible clinicians participating in MACRA’s Merit-Based Incentive Payment System (MIPS) in 2017 earned a positive payment adjustment, CMS Administrator Seema Verma recently reported. “These results...

Exploring Changes to the Quality Payment Program in 2019

by Jacqueline LaPointe

The final 2019 Medicare Physician Fee Schedule (PFS) rule contained a number of changes to evaluation and management (E/M) payment rates, site-neutral payments, and remote patient monitoring coverage. But the rule also included key MACRA...

Maximizing MIPS Scores Through Chronic Disease Prevention

by Jacqueline LaPointe

The healthcare industry is moving beyond a “sick care” system and shifting to chronic disease prevention to lower costs and improve quality. However, the healthcare payment system is just catching up to the preventative care...

Exploring Virtual Groups in the Quality Payment Program, MIPS

by Jacqueline LaPointe

Virtual groups enable independent physicians and clinicians in small practices to participate in Medicare’s historic push to transition to value-based reimbursement: the Quality Payment Program. The Quality Payment Program, or QPP,...

Quality Payment Program Top Regulatory Burden for Practices

by Jacqueline LaPointe

For the second year in a row, medical practice leaders said the Quality Payment Program was their top regulatory burden in 2018. Eighty-percent of the 426 group practice leaders recently surveyed by the Medical Group Management...

CMS Finds Errors in 2019 MIPS Payment Adjustment Calculations

by Jacqueline LaPointe

CMS recently announced that it is extending the targeted review deadline for 2017 Merit-Based Incentive Payment System (MIPS) performance feedback after the federal agency identified three errors with the scoring logic for the 2019 payment...

Developing a 2018 MIPS Reporting Strategy to Avoid a Penalty

by Jacqueline LaPointe

Eligible clinicians can avoid a financial penalty under the Merit-Based Incentive Payment System (MIPS) in 2020 by focusing their reporting on one of three performance categories: Quality, Improvement Activities, or Promoting...

Do Proposed Quality Payment Program Changes Support Specialists?

by Jacqueline LaPointe

The American Society of Clinical Oncology (ASCO) recently expressed their concerns with proposed Quality Payment Program changes, arguing the potential implementation policies for the third year of the program do not align with specialty...

How Can CMS Improve MACRA’s Quality Payment Program, MIPS?

by Jacqueline LaPointe

While providers commend CMS for replacing the Sustainable Growth Rate with MACRA and its Quality Payment Program, many still have some reservations about the Medicare program. After completing the first Quality Payment Program performance...

CMS Misses Chance to Move Physician Pay, QPP to Value, AMGA Says

by Jacqueline LaPointe

CMS recently proposed several changes to Medicare physician payments and MACRA’s Quality Payment Program to reduce medical billing and administrative burden. But initial reactions from medical group associations have not been...

CMS Proposes 2019 Physician Payment, Quality Payment Program Changes

by Jacqueline LaPointe

CMS recently proposed major changes to Medicare physician payments and the Quality Payment Program to reduce the administrative burden of medical billing. The potential changes in the Medicare Physician Fee Schedule would save individual...

Stakeholders Want Greater MIPS Participation for Higher Rewards

by Jacqueline LaPointe

Policymakers and industry groups are calling on CMS to include more Medicare providers in MACRA’s Merit-Based Incentive Payment System (MIPS). Five members of Congress, all of whom are part of the House GOP Doctors Caucus, recently...

EHR Costs, Staffing Still Trouble Small, Rural Practices in MIPS

by Jacqueline LaPointe

Financial challenges plaguing small and rural practices under legacy Medicare value-based purchasing programs are likely to persistent under the Merit-Based Incentive Payment System (MIPS), the Government Accountability Office (GAO)...

CMS to Waive MIPS for Providers in At-Risk Medicare Advantage Plans

by Jacqueline LaPointe

CMS recently announced that it advanced a demonstration that would waive Merit-Based Incentive Payment System (MIPS) requirements for eligible clinicians participating in at-risk Medicare Advantage plans. If approved, the Medicare...

Level the Playing Field for Medicare Advantage in MACRA, Orgs Urge

by Jacqueline LaPointe

Eleven industry groups are urging CMS to include Medicare Advantage (MA) in MACRA as soon as possible to provide the same incentives to eligible clinicians in risk-based MA models as those offered to clinicians in Medicare Advanced...

91% of Eligible Clinicians Participated in 2017 MIPS Reporting

by Jacqueline LaPointe

Approximately 91 percent of all eligible clinicians participated in 2017 Merit-Based Incentive Payment System (MIPS) reporting, exceeding the CMS goal of 90 percent participation in the first year of the Quality Payment Program, the...

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