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9:55-10:45 a.m.

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The CMS Quality Payment Program (MACRA) in 2020 and 2021

Presenters at this session will provide an in-depth review of the requirements for the CMS Quality Payment Program (QPP) in the 2020 performance year. They will also review proposed changes for the 2021 performance year, potential audit vulnerabilities and the impact of the COVID-19 pandemic.

The QPP has two tracks, the Merit-based Incentive Performance System (MIPS) and Advanced Alternative Payment Models (APMs). The MIPS is associated with positive and negative payment adjustments based on a performance score. Payment adjustments range from negative 9 percent to positive 9 percent in the corresponding payment year. CMS is gradually increasing the threshold that determines whether practices receive a positive or negative payment adjustment. By the year 2022 this threshold will be based on the average performance of all MIPS participants. It is anticipated that practices will need to achieve scores in excess of 75 to 80 points to avoid penalties in 2022. However, this will greatly increase the pool of funds available to high-performing clinicians and groups, markedly increasing the return on investment for engaged healthcare organizations.

Presenters will also provide detailed insight as to how to optimize performance in the MIPS program. They will include an understanding of how to improve scores in the quality, cost, promoting interoperability, and improvement activity performance categories of MIPS.

In addition, they will address the increased importance of risk adjustment/HCC coding in the MIPS and Advanced APMs. CMS initially targeted greater involvement of practices in Advanced APMs but the availability of these models has been limited. This presentation will review the CMS-approved Advanced APMs for the 2020 and 2021 performance years and discuss the potential benefits and pitfalls of engaging in one of these models. Finally, presenters will review QPP audit vulnerabilities and the role of CDI in avoiding negative audits and associated penalties.

Learner Outcomes

Participants in this session will:

• Learn about the status of the Quality Payment Program, including MIPS, in 2020 and 2021, in light of the public health emergency.
• Understand how the CMS Quality Payment Program (MACRA) is evolving.
• Learn why it will become increasingly challenging to avoid penalties in the near future, but also how financial rewards will increase for high performers.
• Learn how to optimize quality, promoting interoperability, cost, and improvement activity performance in the Merit-based Incentive Payment System (MIPS).
• Gain an understanding of advanced alternative payment models available in 2020 and 2021.
• Become familiar with detailed reporting requirements for MIPS in 2020.
• Learn about finalized and proposed changes to the Quality Payment Program for the 2021 performance year.
• Learn about Quality Payment Program audits and how to reduce the risk of negative audits that could result in substantial financial penalties.
• Gain an understanding of how risk adjustment is used to determine performance in the MIPS and alternative payment models.


Michael Stearns, MD, CPC, CRC, CFPC
Apollo HIT, LLC Austin, TX
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