APMs: Advanced APMs Minimum CEHRT Use Threshold
We are increasing the CEHRT use threshold for Advanced APMs so that an Advanced APM must require at least 75% of eligible clinicians in each APM Entity use CEHRT to document and communicate clinical care with patients and other health care professionals.
APMs: MIPS Comparable Measures
We are amending the Advanced APM quality criteria to state that at least one of the quality measures upon which an Advanced APM bases payment must be:
On the MIPS final list,
Endorsed by a consensus-based entity, or
Otherwise determined by CMS to be evidence-based, reliable, and valid. This provision applies beginning in 2020
APMs: Outcome Measures
We are amending the Advanced APM quality criterion to require that the outcome measure used must be evidence-based, reliable and valid. The outcome measure used in an Advance APM must be:
On the MIPS final list,
Endorsed by a consensus-based entity, or
Otherwise determined by CMS to be evidence-based, reliable, and valid. This provision applies beginning in 2020
APMs: Revenue-Based Nominal Amount Standard
We are maintaining the revenue-based nominal amount standard for Advanced APMs at 8% through performance year 2024.
APMs: Payer-Initiated Process for Remaining Other Payers
We are implementing the previously finalized policy without modification, and allowing all payer types to be included in the 2019 Payer Initiated Process for the 2020 QP Performance Period.
APMs: Addition of TIN Level All-Payer QP Determinations
Beginning in 2019, we will allow for QP determinations under the All-Payer Option to be requested at the TIN level, in addition to the APM Entity and individual eligible clinician levels, when all eligible clinicians who have reassigned their billing rights to the TIN are included in a single APM Entity.
APMs: Multi-Year Other Payer Advanced APM Determinations
We are maintaining annual submissions but streamlining the process for multi-year arrangements such that, at the time of the initial submission, the payer and/or eligible clinician will provide information on the length of the agreement, and attest at the outset that they will submit information about any material changes to the payment arrangement during its duration.
In subsequent years, if there were no changes to the payment arrangement, the payer and/or eligible clinician do not have to annually attest that there were no changes to the payment arrangement.
APMs: Other Payer Advanced APM Revenue-Based Nominal Amount Standard
We are maintaining the revenue-based nominal amount standard for Other Payer Advanced APMs at 8% through performance year 2024
APMs: Other Payer Advanced APMs Minimum CEHRT Use Threshold
We are increasing the CEHRT use criterion threshold for Other Payer Advanced APMs so that in order to qualify as an Other Payer Advanced APM as of January 1, 2020, CEHRT must be used by 75% of eligible clinicians participating in the payment arrangement to document and communicate clinical care, whether or not CEHRT use is explicitly required under the terms of the payment arrangement.
APMs: Use of CEHRT criterion for Other Payer Advanced APMs
We are modifying the CEHRT use criterion for Other Payer Advanced APMs to allow either payers or eligible clinicians to submit evidence demonstrating that CEHRT is actually used at the required threshold level to be an Other Payer Advanced APM.
APMs: Revising the MIPS APM criteria
We are reordering the wording of this criterion to state that the APM “bases payment on quality measures and cost/utilization.” This clarifies that the cost/utilization part of the policy is broader than specifically requiring the use of a cost/utilization measure.
https://qpp.cms.gov/
https://www.qppresourcecenter.com/
https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf
https://www.federalregister.gov/documents/2016/11/04/2016-25240/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm
To help clarify some of the terms surrounding Medicare Access and CHIP Reauthorization Act (MACRA), the AMA has compiled a list of acronyms, terms and definitions.
ABC™ - Achievable Benchmark of Care
ACO - accountable care organization
AHRQ - Agency for HealthCare Research and Quality
APM - alternative payment model
APRN - advanced practice registered nurse
ASPE - HHS’ Office of the Assistant Secretary for Planning and Evaluation
AUC - appropriate use criteria
BPCI - bundled payments for care improvement
CAH - critical access hospital
CAHPS - Consumer Assessment of Healthcare Providers and Systems
CBSA - non-core based statistical area
CDS - clinical decision support
CEHRT - certified EHR technology
CFR - Code of Federal Regulations
CHIP - Children’s Health Insurance Program
CJR - comprehensive care for joint replacement
CMMI - Center for Medicare & Medicaid Innovation (CMS Innovation Center)
CMS - Centers for Medicare and Medicaid Services
COI - collection of information
CPIA - clinical practice improvement activity
CPOE - computerized provider order entry
CPR - customary, prevailing and reasonable
CPS - composite performance score
CPT - Current Procedural Terminology
CQM - clinical quality measure
CY - calendar year
DPP - diabetes prevention program
eCQM - Electronic Clinician Quality Measure
ED - Emergency Department
EHR - electronic health record
EP - eligible professional
ESRD - End-stage Renal Disease
FFS - fee for service
FQHC - federally qualified health center
FR - Federal Register
GAO - Government Accountability Office
GPCI - Geographic Practice Cost Index
HAC - hospital-acquired condition
HCAHPS - Hospice Consumer Assessment of Healthcare Providers and Systems
HHS - Department of Health & Human Services
HIE - Health Information Exchange
HIPAA - Health Insurance Portability and Accountability Act of 1996
HITECH - Health Information Technology for Economic and Clinical Health
HOPD - Hospital Outpatient Department
HPSA - health professional shortage area
HRSA - Health Resources and Services Administration
IHS - Indian Health Service
IPAB - Independent Payment Advisory Board
IT - information technology
LDO - large dialysis organization
MA - medical assistant
MAC - Medicare Administrative Contractor
MACRA - Medicare Access and CHIP Reauthorization Act of 2015
MedPAC - Medicare Payment Advisory Commission
MEI - Medicare Economic Index
MIPAA - Medicare Improvements for Patients and Providers Act of 2008
MIPS - Merit-based Incentive Payment System
MLR - minimum loss rate
MSPB - Medicare spending per beneficiary
MSR - minimum savings rate
MU - Meaningful Use
MUA - medically underserved area
NCQA - National Committee for Quality Assurance
NPI - National Provider Identifier
NQF - National Quality Forum
OCM - Oncology Care Model
OIG - Office of the Inspector General
ONC - Office of the National Coordinator for Health Information Technology
PCMH - patient-centered medical home
PCORI - Patient-centered Outcomes Research Institute
PECOS - Medicare Provider Enrollment, Chain and Ownership System
PFPMs - physician-focused payment models
PFS - physician fee schedule
PHS - public health service
PPS - prospective payment system
PQRS - Physician Quality Reporting System
PTAC - Physician-focused Payment Model Technical Advisory Committee
QCDR - qualified clinical data registry
QIO - quality improvement organization
QP - qualifying APM participant
QPP - Quality Payment Program
QRDA - quality reporting document architecture
QRUR - quality and resource use reports
RAC - recovery audit contractor
RBRVS - Resource-based Relative Value Scale
RFI - request for information
RHC - rural health clinic
RIA - regulatory impact analysis
RVU - relative value unit
SGR - sustainable growth rate
TCPI - Transforming Clinical Practice Initiative
TIN - tax identification number
VBM - value-based payment modifier
VPS - volume performance standard