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Preparing Providers for Full MACRA Implementation in 2022

“With the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS did away with the Sustainable Growth Rate model. Now, they are able to reward high-value, high-quality Medicare clinicians with payment increases, while at the same time reducing payments to those clinicians who aren’t meeting performance standards.

ACOs will be one of the main groups impacted by upcoming changes to the MACRA program. Starting in 2021, they will no longer be managing the Quality reporting for their physician groups. Therefore, ambulatory providers will need to start analyzing and submitting their measures from their EHR.

But other providers, such as hospital-based providers, generally don’t have the EHR necessary to generate MIPS measures, which means that these groups will need to contract with a certified registry or QCDR.”

  • Source: https://revcycleintelligence.com/news/preparing-providers-for-full-macra-implementation-in-2022

“Zatera Medical Consultants is comprised of a highly skilled team of business professionals and healthcare specialists that unlock and drive substantial revenue to practices.”

If you’re currently working with a Medicare Shared Savings Program (MSSP), be sure to ask yourself the following questions:

  • Does my MSSP advance me a capitation payment of either $30 per traditional Medicare patient per month or 115% of my billed encounters last year?
  • Does it also allow me to keep 100% of my “fee for service” revenue?
  • Does it allow me to participate in and keep my earned bonuses on top of these two items?
  • Are you sharing these risks with your program sponsors or are they taking that risk for you to protect from losses?

Our product provider is the only one presently to have contracts with two different Direct Contracting Entities (DCEs) for CMS, paying capitation payments to providers for their qualifying (traditional) Medicare patients. In our program, the provider gets all of the benefits of the bulleted items above.

REALITY – Some of these new MSSPs are largely ACO and Medicare Advantage plan structures overlayed to capture traditional Medicare patients. Why? In the last four years, Medicare Advantage programs have fallen out of favor with patients and CMS to 40% of the market — when they used to command over 60%.

How come? Patients don’t like the higher deductibles, co-payments and service restrictions.

Regardless of the plan: compliance and metrics matter to CMS. This is exactly why our provider has been selected by these DCE’s. Our technology is the institutional grading and ranking system used to determine exactly what is expected of each and every patient.

With each encounter new medical necessities are determined in seven categories, and dynamic care plans are automatically generated.

In this case, you can’t save your way to prosperity and shared savings. In these other programs, the only way to assure savings is to restrict certain services.

Not only do we drastically improve compliance, but the missed revenue for NON-compliance often equates into the hundreds of thousands of dollars.

Ready to learn more and see how much money we can bring into your practice?