This is the CMS Medicaid in the Quality Payment Program training module brought to you by Relias Learning. This module will explore what quality payment programs are and who can participate. You will also cover Alternative Payment Models (APMs) and Advanced APMs, and Other Payer Advanced APMs with the criteria to be considered for each of these programs. You will then learn about Qualifying APM Participants (QPs), how payments apply to QP determinations, threshold scores, and payer combination options. Lastly, the Physician-Focused Payment Model Technical Advisory Committee (PTAC) will be discussed. This module is designed for presentation to trainers and other information givers. It can be easily adapted for presentations to groups of beneficiaries.
Section 1: Introduction A. About This Course B. Learning Objectives Section 2: What is the Quality Payment Program? A. Medicare Payment Prior to MACRA B. The Quality Payment Program C. Summary Section 3: Who Participates? A. Who Participates in MIPS? B. Who is Excluded from MIPS? C. Pick Your Pace for Participation During the Transitional Year D. Review E. Summary Section 4: Alternative Payment Models (APMs) A. What is an Alternative Payment Model (APM)? B. Alternative Payment Models C. Advanced Alternative Payment Models D. What are the Benefits of Participating in an Advanced APM as a Qualifying APM Participant (QP)? E. The Quality Payment Program Provides Additional Rewards for Participating in APMs F. Advanced APMs Must Meet Certain Criteria G. Advanced APMs in 2017 H. Future Advanced APM Opportunities I. Review J. Summary Section 5: Medicaid and Private Payers A. Medicaid Medical Home Model B. Other Payer Advanced APMs Must Meet Certain Criteria C. Other Payer Advanced APM Criterion 1: Requires use of Certified EHR Technology D. Other Payer Advanced APM Criterion 2: Requires MIPS-Comparable Quality Measures E. Other Payer Advanced APM Criterion 3: Medical Home Expanded Under CMS Authority F. Medicaid Medical Home Model Criterion 3: Bear a More than Nominal Amount of Financial Risk G. Review H. Summary Section 6: Qualifying APM Participants (QPs) A. What is a Qualifying APM Participant (QP)? B. Do Payments from Other Payers Apply to QP Determination? C. What is the Performance Period for QPs? D. All-Payer Combination Option: How Do Eligible Clinicians Become Qualifying APM Participants? – Step 1 E. All-Payer Combination Option: How Do You Calculate Threshold Scores? – Step 2 F. All-Payer Combination Option: How Do Eligible Clinicians Become Qualifying APM Participants? – Step 3 G. QP Determination Tree Payment Years 2021 - 2022 H. All-Payer Combination Option: How Do Eligible Clinicians Become Qualifying APM Participants? – Step 4 I. Review J. Summary Section 7: Additional Topics A. Meaningful Use in Medicaid B. Impact on Indian Health Service (IHS) and Tribes C. Physician-Focused Payment Model Technical Advisory Committee D. PFPM Technical Advisory Committee (PTAC) E. How Does the PTAC Work? F. Review G. Summary Section 8: Conclusion A. Summary B. Course Contributor C. Resources D. References E. Congratulations!
The core components of this training module were developed and approved by the Centers for Medicare & Medicaid Services National Training Program (NTP). The original CMS content was enhanced with the addition of interactive vignettes, brought to you by Relias Learning. Disclosure: Centers for Medicare & Medicaid Services National Training Program has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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