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Will Quality Payment Program impacting Medicare Reimbursement?

November 17, 2016



Will Quality Payment Program impacting Medicare Reimbursement?

There are certain measurements taken every year in the field of Medicare that impacts almost everybody, commencing with the physicians. Notwithstanding, the medical billing and coding perquisites also needs to be modified accordingly to get acclimatized with the change in scenario. Quality Payment Program is one such initiative where several impacts will be felt for Medicare reimbursement.

For over 20 years, Medicare has paid doctors in a similar way. The Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA) of 2015 called for real changes in the physician reimbursement framework that will start to produce results in 2017. This new payment framework—the Quality Payment Program (QPP) — keeps on propelling a policy goal of basing payment on value rather volume. What this also means is that the doctor's facilities will now have to be more organized and educated while billing the patients and coding them for the right procedures to avoid any reimbursement delays and claims denials.

About the Quality Payment Program

The Quality Payment Program offers qualified clinicians a few verification tracks in 2017 that will decide Medicare repayment changes in 2019. With the final rule on MACRA execution at last developing, qualified clinicians were given a range of Quality Payment Program participation options that would affect Medicare reimbursement adjustments in 2019.

The Quality Payment Program will commence from Jan. 1, 2017 and qualified clinicians are requested to submit quality performance data to CMS by Mar. 31, 2018. CMS will then give input on the performance and make the proper reimbursements conformities for 2019 Medicare repayments. In any case, the final rule classified four adaptable MACRA attestation options for the 2017 performance year that laid out what qualified clinicians must do to keep away from negative payment modification in 2019 and expand value based reimbursements.

According to the final rule, these transition year arrangements for CY 2017 will empower participation by clinicians and will give an increase period to clinicians to get ready for higher performance limits in the second year of the program.

So, what are the most effective methods to stay away from negative impacts of Medicare reimbursements?

  1. The CMS has already declared that 2017 performance year will go about as a transition period to help eligible physicians get ready for the new value based Medicare Reimbursement Program. Eligible physicians have the option to decide as to whether they want to be a part of the Quality Payment Program. But if they choose the option to not participate then they will get a negative four percent Medicare reimbursement adjustment in 2019.
  2. Insurance providers can keep away from a descending adjustment by presenting some of the 2017 performance data to the Merit-Based Incentive Payment System (MIPS) by Mar. 31, 2018. The final rule lowered the MIPS performance to three points amid the transition year, which means physicians must provide details on at least one measure to anticipate negative Medicare Reimbursement.
  3. Under the testing attestation track, qualified clinicians can give an account of at least one quality execution measure, one improvement activity or the required measures in the propelling care information component.

The Quality Payment Program will roll at the start of 2017, and as you must have read in the above article, it will prove beneficial Medicare Reimbursement. A doctor's facility however, needs to train their staff for the upcoming changes and another great move would be too avail the services of an outsourced medical billing and coding agency for a streamline transition into the Quality Payment Program.

 

Category : Best Billing and Coding Practices