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Your Guide to MACRA & MIPS

Meaningful Use helped hundreds of thousands of independent physicians afford adding EHR to their practices. Since 2015, much has changed. The primary goal with MACRA is to improve care for Medicare patients. MACRA shifts the payment system from volume to value and results.

As an ONC 2015 Certified EHR, AdvancedMD software meets and satisfies all the MACRA-related requirements. MACRA (Medicare Access and CHIP Reauthorization Act of 2015) introduces a new value-based reimbursement system called the Quality Payment Program (QPP) with three important changes impacting your Medicare payments.

MIPS/APMs
Created a new framework for rewarding physicians for providing higher quality care. The two tracks of the QPP are:

  • Merit-based Incentive Payment System (MIPS)
  • Alternative Payment Models (APMs)

SGR
Repealed the Medicare sustainable growth rate (SGR) formula that calculated payment cuts for physicians

Consolidates
Parts of three previous individual reporting programs are combined into a single system:

  • Physician Quality Reporting System (PQRS)
  • Value-Based Payment Modifier (VBPM)
  • Medicare’s Meaningful Use (MU)

Patient Medical Snapshot

The patient chart displays & confirms data such as patient medications, allergies, problem list, smoking status & test results.

Apply Codesets to Note Template Fields

Quality Measures are calculated using ICD-10, CPT, LOINC & SNOMED codes.

Patient Portal

24/7 access for your patients to see their health records

Telemedicine

Telemedicine can maximize your IA performance category score.

Clinical Patient Listing

Lets you generate reports of patients based on gender, age, problem/diagnosis & test results.

Patient Data Storage

Once entered into the electronic chart, patient data is retained helping you meet the MACRA objectives.

Patient Education

Link to your favorite educational websites & share the information with your patients.

Understand the basics of MIPS

MIPS (Merit-based Incentive Payment System) is a program measuring an eligible clinician’s performance and comparing it with their peers.  MIPS is a budget neutral program; the positive Medicare payment adjustments are funded by those receiving negative payment adjustments.  The payment adjustments are applied to Medicare Part B payments for  covered professional services two years after the performance period—the MIPS Total Score earned in 2019 (MIPS Year 3) will be applied to Medicare payments in 2021.

Download the MACRA acronyms sheet

Learn the 2019 performance category weights for MIPS

Quality
45%, 12 months

6 Measures


Promoting Interoperability
PI (formerly ACI) – 25%

Attest to 6 required measures, and 2 optional bonus measures, for a minimum of 90 days


Improvement Activities
(aka from proposed rule CPIA) – 15%

Complete 1-4 improvement activities for a minimum of 90 days


Cost
15%, 12 months

Download MIPS Category Scoring Overview

Take a closer look at APMs

The second option for participation in MACRA is the APM track where eligible clinicians can apply to and become “Qualified Participants” with an Advanced APM and earn 5% payment incentives. Advanced APMs entities focus on providing high-quality and cost-efficient care—they can focus on specific clinical conditions, care episodes, or patient populations.

CMS’s QPP website has resources to help clinicians decide if participation with an APM is right for them and lists those that are approved for the MACRA QPP. Many previously existing ACOs are on Medicare’s list of Advanced APMs. If you are interested in becoming a QP with an APM we suggest:

  1. Online research for specific requirements for the approved Advanced APMs.
    QPP.CMS.GOV – APMs tab (https://qpp.cms.gov/apms/overview)
    CMS Innovation Center webpage (https://innovation.cms.gov/initiatives/#views=models)
    Shared Savings Program webpage (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/about.html)
  2. Verify that the APM you are interested in is accepting applications and that you meet the requirements.
  3. Apply to an APM that fits your practice.

AdvancedMD meets EHR regulations with less hassle for you

Having a tough time getting up to speed with the new MACRA & MIPS requirements?

You’re not alone. Our MIPS Consultants have the expertise to help guide you through the maze of MIPS to give you the tools to achieve a positive MIPS score.

CHPL Product Number: 15.04.04.2666.Adva.12.00.1.181113

API Portal User Guide.

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“The best thing I ever did in private practice was getting AdvancedMD—it has liberated me.”

Estaban Lavato, MD
La Loma Medical Center

“The nice thing about AdvancedMD is claims are cleared before they are forwarded to various insurance companies. We know very, very quickly if we have some defective portion on our claim.”

Dwight Romriell, DMD

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“[Our] patients are very well-educated and well-informed, and they want to see results quickly. The practice has to run extremely efficiently and be accessible to them. The nice thing about [AdvancedMD] is it has allowed me to be more efficient both in and out of the office. Now I don’t have to come back into the office, which is great for my family and everything else. It saves me a lot of time – probably an hour a day on the three days I work in the second office.”

Keith Berkowitz, MD
Center for Balanced Health

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“Everybody still does basically the same thing; they just do it in a different and better way that’s more efficient.”

Steve Wampler, MD
Greenhill Family Clinic

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