In our last blog about coding concerns in the New Year, we listed the new Quality Payment Program, noting that 50 percent of physicians say they are in the dark as to its meaning and ramifications on documentation, coding and reimbursement. Having raised the issue, we thought it only fair to shine a little more light on it and pass on a few more tips on readiness.

In October 2016, the Centers for Medicare & Medicaid Services (CMS) released the final rule for implementation of the Program, designed, quite simply, to eliminate defined Medicare payments for services rendered, basing income potential instead on quality outcomes and costs of care.

Part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the initiative, according to CMS Acting Administrator Andy Slavitt, aims to create a more modern, patient-centered Medicare program by promoting quality patient care while controlling escalating costs through the Merit-Based Incentive Payment System (MIPS) and incentive payments for Advanced Alternative Payment Models (Advanced APMs).

The CMS also introduced the new Quality Payment website to explain the program and help clinicians identify the measures and activities most meaningful to their practice or specialty and see how incentives are intended to work. The site should be valuable to practices that, as we advised, are tasking their revenue cycle staff with understanding this new policy.

It won’t be easy, however, because, as noted in an article on HIStalk, the buzz around MACRA has focused on quality reporting and cost reduction, not the impact on revenue cycle operations. That said, the article offered suggestions to help focus in potential effects. They included:

  • Know your data. Pin down exactly the percentage of patients tired to which payers and plan accordingly.
  • Revisit and retool coding. Make sure current documentation and coding processes accurately reflect the care provided.
  • Assure coders are completely knowledgeable in, and consistently applying, ICD-10, including newly added diagnoses codes.

MACRA represents a huge stride in the march to quality-based payment, but it will take some time before that journey is complete. In that time, physician practices are well advised to get their coding and reporting staff and processes in shape and ready for whatever the new law and the future of reimbursement may bring.

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