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Comprehensive Care For Joint Replacement

The Centers for Medicare & Medicaid Services (CMS) recently announced new arrangements for payments that will be qualified as Advanced Alternative Payment Models (APMs) under the Quality Payment Program (QPP) that is planned to start in the 2018 performance year.

Those physicians and eligible clinicians who get some percent of revenue from the Advanced APMs will be exempt from the penalties and requirements of Merit-Based Incentive Payment System (MIPS) and they will be eligible to receive five percent annual bonuses for five years, starting from 2019.

The new models to be qualified under Advanced APMs include Comprehensive Care for Joint Replacement (CCJR), the Advancing Care Coordination that is made through Episode Payment Models, and Accountable Care Organization (ACO) track 1+, which is a new voluntary bundled payment model (details about this model are not yet disclosed by CMS).

The agency is also expecting to reopen applications for new payers and practices in their Comprehensive Primary Care Plus (CPC+) program as well as new participants in their Next Generation ACO model that is aimed for the 2018 performance year.

All the above programs are part of an effort by CMS to bring maximum number of physicians to groups and networks that can deliver value-based care, which is defined as higher quality in a lower cost. Advanced APMs are designed in a way to offer value based care and it is expected by CMS that 125,000 physicians will take part in the models in the year 2018.

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The Medicare Shared Savings Program (MSSP)

ACO track 1+ program will be part of the Medicare Shared Savings Program (MSSP). The current MSSP has three other tracks and most of the ACOs take part in track 1, and it does not have any tricky risks. Only the second and third tracks qualify as Advanced APMs and they require the ACO to take downside risk. The track 1+ will also need taking financial responsibility but the amount of Medicare practice revenue that will be at risk for the first two years will go only up to eight percent.

While announcing the final rule for the MACRA at a recent press conference, CMS Acting Administrator Andy Slavitt said that the first track is designed to make it “more reasonable and tenable for small practices” to take part in ACOs that take risk from CMS. Apart from the losses cap, he pointed to the upside opportunity and the five percent annual bonus that is guaranteed to the clinicians and physicians who join Advanced APMs.