MACRA: Transitioning Payment Methods

Start now to ensure your business processes support MIPS and APM requirements.

Editor Note: The Merit-based Incentive Program (MIPS) and Advanced Alternate Payment Model (APM) requirements are finalized. Now, we’re just weeks away from the start of the first performance period. AAPC has been covering news of the Quality Payment Program from the start. The following article, which first appeared in Healthcare Business Monthly, is a comprehensive explanation of what quality-based payment is today and how it may affect you in the near future...

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Medicare Quality Payment Programs

The way healthcare professionals are paid under Medicare has been transitioning from a volume-based payment system to a value-based payment system, for years. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) called for the Centers for Medicare & Medicaid Services (CMS) to step up their efforts. CMS responded with the Quality Payment Program, which offers two tracks for participation: the Merit-based Incentive Payment System (MIPS) and Advanced Alternate Payment Models (APMs)....

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Billing ArticlesAuditing Articles
CLIA Waived Tests Effective January 1, 2017

The Centers for Medicare & Medicaid Services (CMS) has tweaked the tests it says are waived from Clinical Improvement Amendment of 1988 (CLIA), releasing the list effective January 1, 2017.

CLIA regulations require a facility to be certified for each test performed. To ensure that Medicare and Medicaid only pay for laboratory tests categorized as waived complexity under CLIA in facilities with a CLIA certificate of waiver, laboratory claims are edited at the CLIA certificate level ...

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Practice Management Articles
CMS Reveals Little-Known Facts About MIPS

Ever since the Centers for Medicare & Medicaid Services (CMS) released a notice of proposed rulemaking in April for the Merit-based Incentive Payment System (MIPS) and Alternate Payment Model (APM) incentive, staff has been inundated with questions from the healthcare community...

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Compliance Articles
Physician Excluded from Medicare/Medicaid for 20 Years

The Department of Health and Human Services (HHS) Office of Inspector General announced November 15 that Labib Riachi, a New Jersey OB/GYN specializing in urogynecology, agreed to a 20-year exclusion from federal health care programs to resolve allegations that he submitted false claims to Medicare and Medicaid for Pelvic Floor Therapy services that were never provided, or were provided improperly. ...

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Quality Reporting Measures Under Consideration

Public comment is being accepted, for a limited time.

The Centers for Medicare & Medicaid Services (CMS) released on Nov. 22 the List of Measures Under Consideration (MUC) for 2016. The National Quality Forum (NQF) announced the same day that the Measure Applications Partnership (MAP) has begun its annual review of the list...

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