CMS recently released its Calendar Year 2025 Medicare Physician Fee Schedule Final Rule, bringing important changes for healthcare providers participating in the Quality Payment Program (QPP). This update affects the Merit-based Incentive Payment System (MIPS), the Medicare Shared Savings Program (MSSP), and Alternative Payment Models (APMs).

Learn the key exceptions, their deadlines, and why an eligible clinician might apply for them.

The APM Performance Pathway is a vital performance measurement and reporting framework designed for ACOs participating in Advanced Alternative Payment Models (APMs) such as the Medicare Shared Savings Program (MSSP). The APP serves to simplify and streamline quality reporting for ACOs, aligning performance metrics across various APMs, and improving patient care.

On July 10, 2024, CMS released the Calendar Year (CY) 2025 Physician Fee Schedule (PFS) proposed rule outlining proposed changes for Medicare payments under the PFS and other Medicare Part B payment policies.

After the 2024 performance year, CMS will retire the Web Interface, marking a significant shift in reporting requirements for ACOs.

Promoting Interoperability (PI) is a MIPS reporting category that measures how well clinicians and healthcare workers use certified electronic health records (EHRs) technology.

Staying on track with the many key dates and deadlines for the 2024 MIPS reporting year ahead can be challenging if it is not all in one place.

CMS is now accepting submissions for quality and cost measures for future MIPS years.

With the 2024 performance year here, it is crucial for small practices to understand each guideline and optimize scores before it is too late.

On March 11th, CMS made the announcement that the deadline for submitting 2023 MIPS data has been extended.

With the potential financial impact to your practice, it is critical that the 2024 MIPS reporting options are understood.

Dedicating time to create a quality measure selection strategy is critical to achieving a high MIPS score in the future.

The Improving Care for Lower Extremity Joint Repair MVP is comprised of measures most often completed by doctors in the orthopedic specialty.

As we know, Medicare is always moving the target when it comes to quality reporting requirements. One such challenge with MIPS is the penalty avoidance threshold, the minimum amount of points clinicians need to achieve in order to prevent them from receiving a negative payment adjustment on Medicare Part B claims.

Recently, the Centers for Medicare and Medicaid Services (CMS) has finalized a rule focusing on streamlining the prior authorization process.

With the 2024 Final Rule, we have seen many changes and additions to MIPS for the 2024 performance year that are critical to take note of.

As you navigate changes in your professional journey, it's crucial to stay informed about your MIPS Eligibility status. Checking the Quality Payment Program (QPP) Status Tool for the 2023 performance year and your initial 2024 status can provide valuable insights into any modifications to your eligibility.

The CY 2024 Medicare Physician Fee Schedule final rule introduces transformative changes for ACOs, ushering in new reporting requirements that demand strategic adaptation.

The 2024 Medicare Physician Fee Schedule Final Rule has been released and sparked a variety of responses in its wake.

It is essential to understand the differences between MIPS Clinical Quality Measures (MIPS CQMs) and Electronic Clinical Quality Measures (eCQMs).

The final 2024 Medicare Physician Fee Schedule Rule will be out soon and there is little reason to believe it will be much different from the proposed rule, based on past years.

As the countdown continues toward the final 90 days for reporting MIPS there are some specific advantages for small practices worth noting.

Has your practice performed for at least 90 days on Promoting Interoperability and Improvement Activities’ measures? If not, the clock is ticking!

MIPS scores directly affect your Medicare reimbursement payments. According to the Centers for Medicare & Medicaid Services (CMS), Medicare's reimbursement rate is roughly 80% of the total bill.

Who is required to report MIPS? All eligible clinicians are required to report MIPS data. Eligibility status is based on two things, NPI and associated TIN.

MIPS eligible clinicians, groups, and virtual groups are all eligible to submit an application to reweight any or all of the MIPS performance categories if they are/have been affected by rare events entirely outside of their control and the control of the facility where they practice that would

CMS is moving toward the goal of a Learning Health System (LHS) which will measure care quality using standardized, interoperable data from multiple sources and create a digital environment with rapid access to data on a global level.

Breakdown of the total costs of care measure.

Updates to MIPS in 2023.

The anticipated launch of the MIPS value pathways (MVPs) framework by the CMS in 2021 has been delayed by a year due to the acknowledgment of the challenging situations within the healthcare sector as a result of Covid-19. While the MVPs framework had been finalized and ready for release, CMS acknowledged the concerns of the stakeholders regarding the timeline and decided to postpone its implementation to 2022. The organization also recognizes the fact that clinicians are very busy at the moment to address Covid-19.

Making sure that each patient’s goals are incorporated into their treatment plan is a must for providers that hope to maintain high patient satisfaction rates. One way to help maintain and document these goals for alignment is by having patients complete and Advance Care Plan.

As CMS continues the shift towards value based reimbursement models, the healthcare industry has become more focused on evaluating potential benefits from each of the new associated programs. Primary Care First (PCF) has been receiving a lot of attention due to its limited participation options and significant gains associated with success. The PCF program falls under the MACRA umbrella as an Alternative Payment Model (APM) but offers primary care providers a significant opportunity to increase revenue through demonstrated compliance and increased quality of care.

The rule for the 2021 Quality Payment Program, covering the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM), was released at the beginning of the year. Concerns regarding how the COVID-19 pandemic would impact the program for 2020 and 2021, lead to the release of rules for the MIPS.