Alphabet Soup and What it Might Mean to Me
August 24, 2017
written by Amber Rogers
Here is a quick reference table that may be helpful to you and the staff who are working on the various value-based payment work groups within your facility. This is a simplified resource chart to get you started.
| Acronym | Acronym Spelled Out | How this may be relevant to you | Resource Links |
| ACO | Accountable Care Organization | Medicare has 3 ACOs in which organization can participate. The savings an organization realizes is shared between CMS and the organization. Some ACOs are also an Alternative Payment Model. | https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf |
| APM | Alternative Payment Model | There are 2 different types of APM – those that are still subject to MIPS and those that are not. APMs can include a specific clinical condition, episode of care or population. | https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf |
| AAPM | Advanced Alternative Payment Model | AAPMs have 2-sided risk (meaning you can lose money) but they also can receive a 5% incentive payment. | https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf |
| CARC | Claims Adjustment Reason Code | A claim adjustment reason code (CARC) and a remittance advice remark code (RARC) are code sets used to report payment adjustments on an individual EPs or group practice’s Remittance Advice. Both of these code sets are updated three times a year | https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/Understanding2017MedicarePayAdjs.pdf |
| EIDM | Enterprise Identity Management system | You must register on this site to gain access to your QRUR and other CMS feedback reports. | https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Guide-for-Obtaining-a-New-User-EIDM-Account-with-a-Physician-Quality-and-Value-Programs-Role.pdf |
| MACRA | Medicare Access and CHIP Reauthorization Act | The MACRA legislation was a bipartisan regulation that ended the Sustainable Growth Rate formula on Medicare and enacted Value-Based Payment. | https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-programs/macra-mips-and-apms/macra-mips-and-apms.html |
| PCMH | Patient-Centered Medical Home | This is a model of care that puts patients at the center of their care. There are specific guidelines and standards related to patient access, the patient experience and commitment to quality improvement. The national standards for certification is completed by the NCQA (National Committee for Quality Assurance). | http://www.ncqa.org/Programs/Recognition/Practices/Patient-Centered-Medical-Home-PCMH |
For further information and explanation, here is a comprehensive glossary on all things related to Healthcare Payment Reform.
http://www.chqpr.org/downloads/PaymentReformGlossary.pdf
Leave a reply, ask a question or share information using the “Leave a Reply” section below, or email Sharon Phelps directly with your questions or comments.
Other Resource Links
CMS QPP Website
HTS MIPS Services
See all Previous MIPS blogs
Subscribe to the Merit-Based Incentive Payment System (MIPS) Blog
Subscribe
See a list of upcoming webinars
Check out any webinars you missed
Leave a Reply