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Understanding Quality Measures for MIPS, MACRA, and PCMH

MIPS: Merit-based Incentive payment system

MACRA: Medicare Access and CHIP Reauthorization Act 2015

PCMH: Patient centered medical home

There are many different ways to measure health care quality, with MIPS, MACRA, and PCMH being three of the most common. Understanding how each work is crucial for providers.

MIPS measures the quality of care by using a star system. A provider can receive up to five stars for meeting specific quality standards within their specialty.

The MACRA aims to incentivize doctors by rewarding them for improving patient outcomes, such as controlling blood pressure or cholesterol levels.

PCMH is a health care model focused on creating partnerships between patients and providers so that both parties can share information about treatment goals and progress, which will help ensure an optimal health outcome.

Many people might find it challenging to understand how each measure works without knowing how they all differ from one another. This blog will detail each step and why providers must understand them.

HPA medical billing experts having a discussion

The MIPS Quality Measure

Introduction

The Merit-based Incentive Payment System (MIPS) is revolutionizing the healthcare industry by focusing on quality improvement and analyzing providers’ performance.

The Merit-based system has helped during COVID-19 pandemic when other programs were inadequate, resulting in an efficient platform for reporting information about prescriptions filled or procedures done with minimal hassle!

These benefits can add up to increased financial success for the medical practices. By implementing a well-designed RCM process, medical practices can improve their bottom line and provide better patient care.

Quality measures

MIPS is a quality measure that assesses providers based on the care they provide. This can be done by using the MIPS quality star rating system. A provider has up to five stars for meeting specific standards within their specialty.

The closer a provider is to five stars, the higher their quality score will be and the more likely they will receive bonus payments from Medicare.

The star ratings are calculated each year, but every time a provider performs services for new patients or changes their practice quality measures.

If a provider’s star rating falls below four, they may get penalized for not providing the appropriate level of care. Providers are encouraged to use this measure to improve the quality of their practice, as it enables them to focus on patient outcomes instead of just service volume.

However, providers should always keep in mind that MIPS focuses on how well providers address patient needs. It doesn’t include many other factors affecting patient outcomes, such as socioeconomic factors or environmental factors like access to healthy foods and clean water.

The MACRA Quality Measure

Introduction

MACRA is a law that aims to improve quality care and reduce fraud in healthcare. The two-track payment program, which was implemented with MACRA’s passage focuses on rewarding physicians who provide high value service while also discouraging schemes where providers are overpaid because of mistakes or false claims made by patients themselves

Quality measures

The MACRA measure is an incentive-based program that rewards providers for improving patient outcomes. The MACRA system is broken up into different quality categories, with each type containing a set of performance measures. The provider can receive one, two, three, or four stars depending on how well they do in the category.

HPA Accountant doing calculations

For example, a category for cardiovascular care includes nine performance measures like controlling blood pressure and cholesterol levels. In order to get four stars in that category, the provider must have met all nine performance measures over the past six months.

It’s important to note that while providers can earn up to five stars per specialty, they can’t get more than four total stars across all things combined.

It’s vital for providers to know what quality measure applies to them to understand how it will be used in their practice.

For example, if your practice specializes in orthopedics and cardiology, you would need to meet the MIPS requirements for orthopedics and MACRA requirements for cardiology specifically because those are the standards within those areas of your practice.

HIPAA written on wooden cubes

The PCMH Quality Measure

Introduction

What if you could have a patient-centered medical home that allows for hassle free interaction with your clients who need healthcare services? With this approach, the best possible care can be provided and everyone will feel like their needs are being met.

Quality Measures

PCMH is a health care model focused on creating relationships between providers and patients. It’s designed to help ensure that the patient’s goals and the provider’s goals are aligned. This can be particularly useful for chronic illnesses, as providers will work with the patient rather than just treating them.

The PCMH quality measure is based on whether or not providers are following the PCMH model of treatment. A provider may receive a “yes” for their PCMH quality measure if they’ve done things like creating treatment plans with their patients and discussed how those plans would fit into these patients’ lives.

Providers can get an “excellent” rating for their PCMH quality measure if they follow up with their patients after treatment and ask them about what worked well, what areas could have been improved, and how specific treatments might be changed in the future.

If you’re interested in learning more about MIPS, MACRA, or PCMH, head over to hpa billing, where all the necessary essential details are mentioned.

Conclusion

MIPS, MACRA, and PCMH are all quality measures with different calculations. Knowing which measure is being calculated can help you better understand the requirements for payment or reimbursement. For your revenue to improve to an enhanced level, complying to these three measures can be the most efficient way. Whether you are a small medical practice or a giant firm, these three quality measures can be beneficial to a greater extent.

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