Billing And Coding Companies

Quality Payment Program

Recent reports show considerable progress towards the implementation of the latest Quality Payment Program by CMS. This program is actually introduced to reward the providers for the value-based care they are offering to customers. However, reports claim that the CMS should address and resolve a few existing vulnerabilities for the success of this program.

An audit from HHS’ Office of the Inspector General identified two serious vulnerabilities that the CMS must resolve in the next year. The authorities urged the CMS to provide technical assistance and necessary guidance to the clinicians in order to ensure that they are ready to take part in the Quality Payment Program. Furthermore, they also asked CMS to develop IT systems that will support payment adjustment, scoring, and data reporting.

The report published by the OIG stated that, “As of December 2016, CMS had finalized key policies to implement the QPP, including issuing final regulations and identifying Medicare models that qualify as Advanced APMs for the first performance period. CMS had also initiated engagement and outreach activities to clinicians, launched a public-facing informational website, and awarded various contracts for technical assistance and training.”

On the other hand, the auditors reported that the CMS “must still expand its technical assistance efforts, issue promised sub-regulatory guidance, award and oversee key contracts, and complete development of backend IT systems necessary to support critical QPP operations.”

Medical Billing Services

Medicaid And Medicare Services

The OIG added that the CMS “faces challenges in building the complex backend IT systems required to receive clinicians’ data, calculate their MIPS scores, and carry out other functions vital to the program’s success.” The auditors stated that building and testing of the IT systems, which support the critical operations of this latest program would certainly require constant and significant effort next year.

The final regulations for the Quality Payment Program were issued by the CMS on October 14, 2016, and reports indicate that January 1, 2017, will mark the beginning of the first performance year. The final payment adjustments will be effective from January 1, 2019.

The latest initiative by CMS is actually a part of the Medicare Access and CHIP Reauthorization Act (MACRA) implementation and it will include Medicare Part B payments for approximately 600,000 clinicians. Physicians can pick either the Advanced Alternate Payment Models (Advanced APMs) or the Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program to be eligible for the reimbursements.