Saturday, January 28, 2017

Medicare establishes 5 percent incentive for practices in the advance payment model under MACRA

Written by Accountable Care Options, LLP

The Centers for Medicare and Medicaid Services finalized rules for its payment program on Nov. 2. They affect practices in advanced alternative payment models, including accountable care organizations, or ACOs.

Practices can earn annual incentives up to 5 percent if they are in ACOs that accept a financial risk for excessive costs in return for a greater percentage of the savings generated. That category includes Medicare Shared Savings Tracks 2 and 3, Next Generation ACO models, Comprehensive ESRD Care Model, Comprehensive Primary Care Plus model and Oncology Care Model.

Practices that receive 25 percent of Medicare payments or see 20 percent of Medicare patients in 2017 through an advanced payment model are eligible to receive a 5 percent incentive payment in 2019.

The good news is that practices in those ACOs have most of the reporting work done for them. Physicians can focus their time and attention on delivering effective, efficient care. They will still need to attest what's called Advancing Care Information measures; they replace meaningful use.

The best way to score well in this area is to perform a security risk analysis - a HIPAA analysis of electronic health records. Evaluate the integrity of your system and the structures that house them. If you discover a security risk, then establish a plan and act on it.

To do well overall, a practice should align itself with an ACO that ranks in the 90th percentile or higher in quality and had a positive 2015 adjustment in the value modifier; the latter was based on measures of quality of care and cost containment.

Practices in the advanced payment model that efficiently treat specific cases and diseases and have also generated shared savings will also earn a positive adjustment. The incentive payment will be delivered directly to the practitioner.

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