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Aug 17, 2017 11:30:00 AM

What Small Medical Groups Need to Know About Virtual Groups - Part 2

By banding together into what CMS has termed “virtual groups,” solo practitioners and small medical groups can take advantage of significant flexibility currently available to help them succeed in the Merit-based Incentive Payment System (MIPS).

In Part 1 of this series, we answered some FAQs about these MIPS virtual groups. In Part 2, we share items to consider before joining a virtual group.

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Topics: MACRA, CMS, MIPs, APMs

Jun 26, 2017 10:00:00 AM

Top Takeaways from MACRA Proposed Rule

With the proposed changes to the Quality Payment Program (QPP) released Wednesday, the new administration aims to reduce some administrative complexity and extend the flexibility that CMS provided in the initial year of the program, while incentivizing more providers to move into Alternative Payment Models (APMs).

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Topics: MACRA, CMS, APMs, Alternative Payment Models

Jun 15, 2017 10:00:00 AM

A Primer on Operationalizing Alternative Payment Models

MACRA’s anticipated future impact on the healthcare industry has many provider organizations contemplating what actions and resources are necessary to participate in alternative payment models (“APMs”). Provider organizations facing the immediate options of getting involved with a CMS or commercial APM have significant operational decisions to make that will impact the future make-up of their organizations. Today we will discuss some of the considerations in preparing for APM participation.

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Topics: MACRA, CMS, APMs, Alternative Payment Models

Mar 31, 2017 10:00:00 AM

3 Insights from AHLA’s Institute on Medicare & Medicaid Payment Issues

Last week’s sudden pull of the American Health Care Act from House vote caused uncertainty around what’s next for the healthcare industry. This week, the AHLA Institute on Medicare and Medicaid Payment Issues, brought together key representatives from CMS, hospital associations and healthcare lawyers from around the nation. Here are three Medicare/Medicaid insights on current and upcoming issues:

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Topics: Medicare, AHLA, CMS, Medicaid

Feb 17, 2017 10:00:00 AM

Let CMS Pay for Your MACRA and ACO Readiness Costs

Welcome to MACRA—the Medicare Access and CHIP Reauthorization Act. MACRA represents the end of a long history of perpetually delayed Medicare physician fee schedule cuts that were to be automatically triggered under the punitive SGR formula absent Congress’ annual postponement ritual. After providing for a series of annual physician payment increases, MACRA’s reimbursement methodology transitions to a value-based model that includes two pathways—the Alternative Payment Model (“APM”) and the Merit-Based Incentive Payment System (“MIPS”).

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Topics: Healthcare, MACRA, CMS

Feb 9, 2017 11:00:00 AM

What Level of MACRA Investment Makes Sense for Rural Hospitals?

Rural hospitals have some tough decisions to make about their level of participation in the new CMS Quality Payment Program created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). 

For a number of reasons, the MACRA cards are stacked against small and rural providers. Given the limited number of Advanced Alternative Payment Models (APMs) that are being approved, many providers will start out in the Merit-Based Incentive Payment System (MIPS), and that track offers limited upside potential compared with APMs.

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Topics: MACRA, CMS, Quality Payment Program

Dec 8, 2016 11:00:00 AM

Will MACRA Fall Victim to Repeal and Replace?

I've just returned from the National MACRA MIPS/APM Summit in Washington, D.C., where the overarching discussion centered on how to create and implement strategies that pay physicians fairly, while controlling spending in the Medicare program. It's a question we've wrestled with for almost 20 years and a challenge we must solve.

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Topics: Medicare, MACRA, CMS, MIPs, APMs

Oct 18, 2016 11:00:00 AM

MACRA Final Rule Released – Actions You Should Take Now

With the release on October 14, 2016 of the Final Rule with Comment Period (Final Rule) for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), titled Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models [CMS-5517-FC], the healthcare industry received some much-awaited clarity around the May 9 Proposed Rule.

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Topics: MACRA, CMS

Sep 29, 2016 11:00:00 AM

New Physician Leases May Be Needed to Avoid Compliance Risk

Did your hospital’s outpatient department begin operations, expand its service lines or relocate after November 2, 2015?

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Topics: CMS, Outpatient Department

Sep 16, 2016 12:00:00 PM

CMS Delays MACRA Implementation; Don’t Slow Your Efforts to Comply

In a move that was widely applauded by medical groups such as the Medical Group Management Association, the American Medical Association, and the American Academy of Family Physicians, CMS announced that it is making the start of MACRA implementation more flexible next year. Although the performance evaluation period may be delayed, the start of payment changes will not be delayed.

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Topics: MACRA, CMS

Sep 8, 2016 10:30:00 AM

Alternative Payment Model Overview: Do You Have the Data to Succeed?

The introduction of the dual track Quality Payment Program within the MACRA proposed rule has many healthcare systems considering their options. My most recent blog focused on the MIPS track of QPP, so today I will focus on an overview of Advanced Alternative Payment Models. 

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Topics: MACRA, CMS, Advanced Payment Models

Sep 1, 2016 11:00:00 AM

Where is Your Data? Why Performing a Data Inventory is Integral in the Digital Age

There’s no denying it—healthcare data has gone digital. The days of paper health records are fast disappearing, and if the Centers for Medicare & Medicaid Services have their way, we won’t be going back. CMS has built meaningful use of electronic health records into its plans for a number of years, and the healthcare industry is responding.

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Topics: Electronic Health Records, Data Security, CMS

Aug 25, 2016 10:00:00 AM

Consumerism is Coming to Healthcare: How Can You Prepare?

Think back to your last car, truck or SUV purchase. What did you want to know before spending so much money?

More than likely, you wanted to know the price range of the type of car you were considering. You might have wanted to know what features were standard on different makes and models. You might even have identified one or two features that you couldn’t live without, and that helped you narrow your choice. You aIso might have wanted to know where to find the best financing. If you’re tech savvy, you probably found much of the information you needed online—even in a single app or website. In recent years, our collective consumer needs have changed the way we buy cars. In fact, consumer preferences have changed the way we buy most things—even healthcare.

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Topics: Quality, MACRA, CMS