Understanding MACRA, MIPS and APMs and the Revenue Cycle Impact

The Medicare Access and CHIP Reauthorization Act (MACRA) authorized two new reporting and reimbursement mechanisms. Both programs are focused on improving physician and other clinician payments by changing the way Medicare incorporates quality measurement into payments which can result in a negative, positive or neutral impact on your revenue cycle.

MACRA advances a forward-looking, coordinated framework for healthcare providers to successfully take part in the CMS Quality Payment Program that rewards value and outcomes in one of two ways:

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

Quality Payment Program Purpose

  1. Support care improvement by focusing on better outcomes for patients, decreased provider burden, and preservation of independent clinical practice;
  2. Promote adoption of Alternative Payment Models that align incentives across healthcare stakeholders; and
  3. Advance existing efforts of Delivery System Reform, including ensuring a smooth transition to a new system that promotes high-quality, efficient care through unification of CMS legacy programs

The Quality Payment Program represents a major change in the way Medicare pays physicians for patient care. As such, developing a clear understanding of the program is critical for successful participation. Organizations should begin discussions with their billing vendors to determine how best to meet the challenges -- and capture the opportunities -- of Medicare’s shifting reimbursement landscape.

web2pro can Help Organizations Navigate MACRA

web2pro Business Performance Services has created several resources to help our customers and their clinicians navigate the transition to MIPS and APMs. Our tenured client managers can assist our customers in determining the approach that best makes sense for their group − MIPS or APMs, individual or group participation, claims-based or registry reporting − as well as which measures are most appropriate for the practice.

web2pro has the expertise and specialty-specific experience hospitals, employed physicians and independent medical practices need to improve overall financial performance and transition to value-based reimbursement. web2pro can help your organization manage daily revenue cycle, financial and operational aspects of your business more effectively so that you can focus on what you do best: delivering quality patient care.