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Merit-Based Incentive Payment Program

In the next few months, CMS will announce a final rule on implementing MACRA. Some Accountable Care Organizations (ACOs) have already started to analyze the new value-based reimbursement plans. Under the proposed changes, only some of the ACOs will be able to qualify as Advanced Alternative Payment Model (APM), where others will be covered under Merit-Based Incentive Payment Program (MIPS).

The National Association of ACOs (NACCOS) has now released a guide on ACO scores under modified version of MIPS that is specifically designed for providers who do not qualify under the Advanced APM system. As per the regulation of MACRA, the Medicare Shared Savings Program (MSSP) Tracks Two and Three and the Next Generation ACO Model will be considered as Advanced Alternative Payment Models.

The advanced ACOs will be exempted from MIPS and will earn a five percent incentive payment. However, eligible clinicians in these chosen ACOs would have to demonstrate participation thresholds to get the incentives.

CMS explained that the participants should treat at least 20% of their patients or should make 25% of the payments via the Advanced APM within the first year of MACRA implementation. The agency also said that the payment thresholds and the patient numbers will increase with time.

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Advanced Alternative Payment Model

For the ACOs that do not qualify for the Advanced APM designations, CMS has further proposed a MIPS APM scoring structure, which would acknowledge the value-based care progress of the ACO model.

These eligible providers will be offered a Composite Performance Score, and the reimbursement adjustments at the end of every performance year will be determined based on this score. CMS will also calculate a score at ACO level for all eligible clinicians under the program.

“This score will be applied to all MIPS eligible clinicians in the group,” the guide stated. “MIPS payment adjustments will be applied at the unique TIN/National Provider Identifier (NPI) level for each MIPS-eligible clinician in the APM Entity group.”

The MIPS APM scoring system will also consider other categories to give the Composite Performance Score as compared to that considered under normal MIPS. Each of the eligible providers will be evaluated based on quality, advance care information, as well as clinical practice improvement activities.

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