The world of bundled payments is constantly changing. Here are answers to a few questions you might have before Model Year 3 of the Bundled Payment for Care Improvement – Advanced (BPCI-A) starts.

(Model Year 3 begins January 1, 2020.)

What is MACRA?

The acronym for the Medicare Access and Chip Reauthorization Act, MACRA mandated the Center for Medicare and Medicaid Services (CMS) to implement a program called the Quality Payment Program (QPP).

QPP changes the way physicians are paid by creating a two-track system for physician payments.

What is MIPS?

The Merit-Based Incentive Payment System (MIPS) is one of the two new ways physicians can change how they receive payments from CMS. Under MIPS, providers are required to report a range of performance metrics. The MIPS program was created to combine previous CMS programs focused on electronic health record (EHR) technology, quality, and cost.

How does MIPS work?

MIPS has four reporting categories: Quality Measures, Promoting Interoperability Measures, Activities, and Cost Measures.

MIPS eligible physicians are required to report data on each of the four categories and, based on category weighting, comprehensive performance scores are used to determine incentive and penalty adjustments.

What are Advanced Alternative Payment Models (APMs)?

The Advanced Alternative Payment Model (Advanced APM) is one of the two new ways physicians can change how they receive payments from CMS. Physicians and providers participating in a program under the Advanced APM track assume financial risk in order to earn the Advanced APM incentive payment.

How do APMs work?

BPCI-A is an advanced APM.

If a provider participates in BPCI-A but does not meet the criteria to become a “Qualified Participant (QP)”, the eligible provider may use a different scoring methodology for MIPS called the MIPS APM scoring methodology.

The MIPS APM scoring methodology has a different weighting of each category, essentially taking the 15% weight assigned to “Cost Measures” and redistributing 5% to each of the other three categories.

Hospitals, PGPs, and ACHs can visit the QPP CMS website and look up the Individual NPI of each physician to learn more about his or her eligibility status under the APM track.

The power of bundled payments to improve care while strengthening the bottom-line of ACHs, PGPs, and providers across the nation is real—but the program is complex.

If you are still confused about BPCI-A, MACRA, MIPS, APM, or any other bundled payment terminology or program, do not hesitate to reach out to Fusion5’s team of bundled payment thought leaders and experts. We are here to answer your questions and look forward to crafting the bundled payment strategy that will best serve your patients, your team, and your organization.

Contact us today at 855-765-8865 or at!

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