Blling managers are uniquely positioned to support clinicians in succeeding under the new program. For example, you can assist physician and other clinical practices in:
- Determining whether they need to participate in the Quality Payment Program (QPP);
- Verifying whether they meet desired thresholds in terms of Medicare fee-for-service (FFS) patient counts and billing amounts;
- Examining the potential impact of various participation options on revenue; and
- Analyzing CMS feedback on cost performance measures.
And, for clinicians who don’t believe they’re prepared to participate, you can help them understand that CMS offers flexible options. We understand that resources and technology vary widely across practices, and we want the broadest participation possible among eligible clinicians. I look forward to continuing to work with the entire healthcare community as we embark on the implementation of the QPP.
In October 2016, HHS launched the QPP with a final rule with comment period implementing certain provisions of MACRA – the Medicare Access and CHIP Reauthorization Act of 2015.
A bipartisan solution, MACRA ended the flawed Sustainable Growth Rate (SGR) formula for Physician Fee Schedule payments, and streamlined existing Medicare quality reporting programs. MACRA was enacted to strengthen Medicare. Clinicians who participate in Medicare are part of a dedicated team that serves 55 million of our country’s most vulnerable Americans. As a result of the SGR formula, physicians and other clinical practices faced payment cliffs for 13 years.
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