Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Quality Payment Program

AHIP Supports Demo of Medicare Advantage Plans as Advanced APMs

November 14, 2017 - AHIP has voiced its support for a CMS demonstration project that would allow Medicare Advantage (MA) plans to qualify as Advanced Alternative Payment Models (APMs), the organization wrote in a statement to CMS. The payer advocacy group believes that the Quality Payment Program (QPP) has the potential to continue high consumer satisfaction rates with MA plans and encourage payers and providers...


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CMS Solicits Payer Participation to Next Phase of CPC+

by Thomas Beaton

In support of second round of payer solicitation for Comprehensive Primary Care Plus (CPC+), The Centers for Medicare & Medicaid Services (CMS) has issued a list of frequently asked questions aimed at increasing payer support for the alternative...

84% of Physicians Unsure of Quality Payment Program Conditions

by Vera Gruessner

As many as 84 percent of polled independent physicians and medical staff are unaware of how to meet the requirements of MACRA’s Quality Payment Program, according to a survey from Kareo. The majority of surveyed physicians, however,...

Medical Organizations Advise Changes for Quality Payment Program

by Vera Gruessner

The healthcare provider community has shown some concern about MACRA implementation and the quality payment program. The Advisory Board released a survey last month showing that 70 percent of 30 medical groups were concerned about MACRA regulations...

Communication Key for Transition to Alternative Payment Models

by Vera Gruessner

Along with health insurers, more and more providers are expected to transition to alternative payment models (APMs) especially due to MACRA’s Quality Payment Program. For example, urology group practices are likely to adopt advanced alternative...

Top 3 Health Insurance Industry Headlines of December 2016

by Vera Gruessner

Now that the final month of the year is wrapping up and everyone is planning their New Year’s celebrations, a review of the most popular headlines for the health insurance industry may be beneficial as we head into 2017. Patients Need More...

Humana Standardizes Healthcare Quality Measures for Physicians

by Vera Gruessner

Last week, Humana announced in a company press release the development of a Clinical Quality Metrics Alignment (CQMA) program meant to simplify and regulate healthcare quality measures. The new strategy will be used specifically among doctors...

MACRA Pushes Payers to Adopt Value-Based Care Payment Models

by Vera Gruessner

This past summer, the Labor Department announced that healthcare spending rose in August more steeply than at any point in more than 30 years. The costs for medical treatment grew by 1 percent in just one month, the Los Angeles Times reported....

Why Value-Based Care Reimbursement, MACRA are Here to Stay

by Vera Gruessner

The outcome of the presidential election has led to some uncertainty throughout the healthcare industry when it comes to legislative changes and medical coverage. However, providers and payers will need to keep a clear head in the coming months...

CMS Commits to Improved Care Quality, Medical Spending Cuts

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) will continue to work toward creating a better healthcare system for patients while keeping close track of medical spending regardless of which political party is in charge, said Andy...

Quality Metrics Pose Problems for Value-Based Care Reimbursement

by Vera Gruessner

The healthcare industry’s fast pace transition to value-based care reimbursement has led to some major challenges for both providers and payers. Adopting completely new payment contracts based on quality metrics is not a simple maneuver...

Payers Benefit from Aligning with MIPS, Value-Based Care

by Vera Gruessner

While healthcare regulations like MACRA legislation often centers around impacting medical providers, the health insurance industry is also integrated into the tapestry of value-based care and alternative payment models. When providers start...

How Payers Could Adjust to MACRA Regulations, Value-Based Care

by Vera Gruessner

MACRA regulations may seem overly complex and lengthy for the average medical practice but there are steps that providers can follow to succeed under MACRA’s quality payment program. Providers can work with payers to better identify similar...

How MACRA Legislation Advances Value-Based Care Reimbursement

by Vera Gruessner

MACRA legislation may play a major part in advancing the adoption of value-based care reimbursement among both payers and providers. CMS Acting Administrator Andy Slavitt emphasized this past May that MACRA legislation will bring real progress...

How MACRA Requirements Impact Accountable Care Organizations

by Vera Gruessner

MACRA legislation impacts a number of healthcare providers and entities including accountable care organizations (ACOs). Only a few Medicare accountable care organizations will actually be able to participate in Advanced Alternative Payment Models...

How Stakeholder Input on Quality Payment Program Differs

by Vera Gruessner

At the end of last week, the Department of Health & Human Services (HHS) released a final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its policies on the new Quality Payment Program. HHS reiterated in a press...

HHS, CMS Announce Finalized Ruling for MACRA Legislation

by Vera Gruessner

The Department of Health & Human Services (HHS) announced in a press release the discharge of the final ruling on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The MACRA legislation replaces the flawed Sustainable Growth...

How MACRA Resolves Sustainable Growth Rate Formula Challenges

by Vera Gruessner

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will likely simplify and improve Medicare reimbursement processes due to the fact that it repeals the flawed sustainable growth rate (SGR) formula. The problems associated with...

CMS Reveals 4 Options for Quality Payment Program Participation

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) is working toward assisting healthcare providers in meeting some new regulations that are part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The meaningful use program...

How the MACRA Rule, Baby Boomers Impact Medicare Payment

by Vera Gruessner

Last month, Andrew Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), spoke at the American Medical Association 2016 Annual Meeting about new strategies to pay for Medicare and unlock opportunities for greater...

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