Frequently Asked Questions

Why use a Consultant Pharmacist?

The Center for Medicare and Medicaid Services (CMS) is calculating clinicians’ reimbursements on a Merit-Based Incentive Payment System (MIPS). A high score earns bonus payments, while a low score incurs penalties.

There are numerous categories of the MIPS composite score that include activities easily performed by a pharmacist. From patient safety to communication with caregivers, medication adherence to suggested lifestyle changes, a pharmacist can help you attain your chosen measures without increasing the workload of current staff.

What is MACRA?

MACRA is the Medicare Access and CHIP Reauthorization Act of 2015. It’s CMS’s (Center for Medicare and Medicaid Services) Quality Payment Program. MACRA is shifting the reimbursement models from a volume-based, fee-for-service system to a value-based payment system. This rule dramatically changes how physicians are compensated for their services under Medicare.

What are the parts of Quality Payment Program?

The Quality Payment Program or QPP is made up of two payment models. The Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APM).

How will MIPS and Advanced APM affect me?

Both pathways allow for potential bonus payments. MIPS is what most practices will participate in. They will incur a penalty, a bonus or no adjustment in their Medicare payments depending on their composite performance score. The data submitted affects payments 2 years later. The adjustments from 2016 performance data are made in 2018, and can be +/- 4% of total Medicare revenue. This increases each year with a +/- 9% adjustment by 2022 for data submitted in 2020.