Seventh Week

During Week 7, I researched the Quality Payment Program which is part of the Medicare Access and CHIP Reauthorization Act of 2015 implemented by the Centers for Medicare and Medicaid Services (CMS) in 2014. The Quality Payment Program is focused on moving the payment system to reward high-value patient care and consists of two tracks: Advanced Alternative Payment Models (APM) and Merit-based Incentive System (MIPS). If the clinic does not participate in the Quality Payment Program, they can receive a negative 4% payment adjustment penalty.

APMs allow clinics to earn Medicare incentive payments by changing to their new payment model. APMs were designed to provide quality and cost-efficient care. Clinics can earn a 5% Medicare incentive payment in 2019 if the clinic receives 25% of Medicare Part B payments through an Advanced APM or if the clinic sees 20% of Medicare patients through an Advanced APM.

MIPS allow clinics to participate in traditional Medicare and earn performance-based adjustments. If the clinic or individual provides the full year of 2017 data, then Medicare will award them a moderate positive or negative payment adjustment for quality and value of care. The CMS estimates 500,000 clinicians will be able to participate in MIPS. These penalties and adjustments will be provided in 2015, however, the CMS believes the adjustment payments will grow to a potential of 9% in 2022.


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