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Medicare's Quality Payment Program and Chiropractic:

Increasing Reimbursement for Services

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Summary
An increase in reimbursement for services is available to chiropractors upon participation in value-based payment models.

In April of 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law. This bipartisan legislation replaced the flawed Sustainable Growth Rate formula for clinician payment in Medicare with a new approach to paying clinicians based on value and quality of care. This began a massive movement away from traditional fee for service towards the value-based reimbursement model. Value-based reimbursement aims to reward providers for performing key clinical activities that directly relate to improved patient outcomes.

CMS began implementing the MACRA law through the Quality Payment Program (QPP) on January 1, 2017. The Quality Payment Program has two payment tracks, the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM). The ultimate goal of CMS is to eventually have all providers in advanced alternative payment models which place a two-way “more than nominal financial risk” or shared risk on providers.

Value-based reimbursement payment models are calculated by using numerous measures of quality and determining the overall health of populations. Unlike the traditional model, value-based care is driven by data because providers must report to payers on specific metrics and demonstrate improvement.

This whitepaper addresses:
1. It All Began with PQRS, Meaningful Use of EHR, and the Value Modifier
2. History of the Low Volume Threshold
3. Success Rate of Participating Providers in Quality Payment Program
4. 2019 and Beyond

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