2020 MACRA Quality Payment Program (eBook)

Optum360 | 2020 | Deborah Hall Karen Prescott Adkins; Kristin Bentley;



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

Item #: EQPP20
ISBN: 9781622546756
Available: CALL 1(800)464-3649, Option 1


Get expert direction on the 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 2020 edition will provide an overview of the program with information to get started or continue with the QPP. Also included are changes proposed and finalized by CMS applicable to the program year. 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, avoid payment penalties, and receive payment incentives.
  • Receive detailed information on reporting options, scoring, and much more.
  • Understand the bigger financial penalties and bonuses that accompany this payment program. 
  • Learn about Advanced APMs including requirements to be a qualifying participant (QP), payments, and scoring.
  • Identify the crucial steps needed to avoid negative payment adjustments and how to become eligible for 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.