2019 MACRA Quality Payment Program (eBook)

Optum360 | 2019 | Deborah Hall Karen Prescott Adkins; Kristin Bentley;



CALL 1(800)464-3649, Option 1
List Price

Item #: EQPP19
ISBN: 9781622544653
Available: CALL 1(800)464-3649, Option 1


Get expert direction on the new Quality Payment Program (QPP) mandated under MACRA, with emphasis on the two participation tracks: 1) the Merit-Based Incentive Payment System (MIPS) and 2) Advanced Alternative Payment Systems (APMs). The 2019 edition will provide an overview of the program, with information to get started with the QPP. Also included are changes proposed and finalized by CMS, with information on the new reporting method virtual groups and performance period reporting requirements, low-volume threshold and scoring, as well as new tips and tools to understand and use Quality Resource and Use Reports (QRURs). Examples and decision trees assist clinicians in understanding how the program works and how to keep up-to-date with the program.

This manual explains, from the physician practice manager’s perspective, how the QPP works and what every clinician needs to know. Review eligibility, data submission methods, each of the four MIPS performance categories, APM scoring, and clinician Physician Quality and Resource Use Reports (QRURs). This manual is a concise guide with special features such as callouts, tables, diagrams, and examples to help clinicians participate in the QPP program.
  • New—Receive detailed information on “pick your pace” reporting options, scoring, and much more.
  • Understand the bigger financial penalties and bonuses that accompany this new payment program.
  • Learn the difference between Alternative Payment Systems (APMs) and Advanced APMs.
  • Identify the crucial steps needed to avoid the negative 4% payment adjustment and how to become eligible for up to 5% in payment bonuses. 

Deborah Hall

Ms. Hall is a new product subject matter expert for Optum360. Ms. Hall has more than 25 years of experience in the health care field. Her experience includes 10 years as office manager for large multi-specialty medical practices. Ms. Hall has written several multi-specialty newsletters and coding and reimbursement manuals, and served as a health care consultant. She has taught seminars on CPT®/HCPCS and ICD-9-CM coding and physician fee schedules. She is an active member of the American Academy of Professional Coders.

Karen Prescott Adkins, CPC, CPC-I, CSS-P

Ms. Adkins has more than 18 years of experience in the health care profession. She has an extensive background in professional component coding and billing. Her prior experience includes establishing and maintaining a coding and billing service, directing physician practice start-ups, functioning as director of physician credentialing, negotiating insurance contracts, and functioning as a health care consultant. Her areas of expertise include coding and reimbursement, documentation education, compliance, practice management, and revenue cycle management. Ms. Adkins is a member of the American Academy of Professional Coders (AAPC), and the American Health Information Management Association (AHIMA).

Kristin Bentley, CPC

Ms. Bentley has 10 years of experience in the health care profession. She has an extensive background in professional component coding, with expertise in radiation therapy, chemotherapy, radiology, and ambulatory surgery procedure coding. She has conducted chart-to-claim audits and physician education. Ms. Bentley has functioned as a billing specialist and has extensive denial management experience. She is an active member of the American Academy of Professional Coders.


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