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Medicare Case Study Essay

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Medicare will be improved through a quality payment program which helps Medicare to target the goal for care quality and making patients healthier which is the most important part of the mission. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) discontinued the Sustainable Growth Rate formula, which made doctors and primary care physicians who participated in Medicare worried about possible payment cliffs for 13 years.

The Quality Payment Program has 2 pathways to choose:
1. Advanced Alternative Payment Models (APMs) - To earn an incentive payment, you have to participate in an Advanced APM, through Medicare Part. You can be a part of the Quality Payment Program in 2017 if you joined the Advanced APM or if you have more than $30,000 worth of Medicare bill which is the allowed charges a year in Part B. The healthcare provider must also see and treat more than 100 Medicare patients a year. It has to meet both the …show more content…
The Merit-based Incentive Payment System (MIPS) - providers will earn a performance-based payment adjustment if they decide to participate in MIPS. The healthcare professionals that can participate in MIPS must be also a Physician, Physician assistant, Nurse practitioner, Clinical nurse specialist and certified registered nurse anesthetist. If they joined in 2017 as their first year in Medicare, then MIPS is not for them.
If they choose the MIPS path of the Quality Payment Program, they have three options which are; submit something, submit a partial year or submit a full year. The MIPS payment adjustment is based on the data submitted. The easiest way to get the maximum MIPS payment adjustment is by participating in full year. They will get the most numbers to pick from, manage more reliable data submissions, and the ability to get bonus points. But if they only report 90 days, they could still earn the maximum adjustment—there is nothing built into the program that automatically gives a reporter a lower score for 90-day

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