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132-S-800-1 Specialist - Messaging Design Elective

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132-S-800-1 exam Dumps Source : Specialist - Messaging Design Elective

Test Code : 132-S-800-1
Test name : Specialist - Messaging Design Elective
Vendor name : Avaya
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Avaya Avaya Specialist - Messaging

Altura Achieves Avaya functions genesis expert Certification | killexams.com true Questions and Pass4sure dumps

FULLERTON, Calif.--(enterprise WIRE)--Altura verbal exchange solutions, an Avaya Platinum BusinessPartner, with workplaces nationwide, is being identified by artery of Avaya, a leading global provider of trade communications purposes, methods and functions, for reaching their capabilities genesis professional (SDS) certification as Implementation expert.

The SDS certification confirms that Altura has skillability in the capabilities and skills obligatory for knowledgeable start of the complete latitude of implementation functions to Avaya customers. Altura is one of a opt for community of Avaya BusinessPartners to obtain the certification.

Altura helps companies Cut back cost and efficaciously dash their operation by means of delivering a wide sweep of elevated satisfactory voice, voice over IP, facts, messaging, instant and come by in palpate with middle purposes and options. operating throughout the U.S., Altura supports thousands of customers including Unisys, Honeywell, Dartmouth Hitchcock clinical core, unusual Jersey Transit, the status of unusual Mexico, the status of Connecticut, and others who come by pleasure from reductions from Altura’s customized functions including network analysis, Contact middle Optimization, and existence Cycle service and guide.

"Altura is honored to be recognized via Avaya for their number 1 rated features," in keeping with Bob Blazek, CEO and President of Altura. "The Avaya SDS designation signifies to their customers that Altura continues to steer the box in training, setting up the requisite capabilities and credentials to exceed their functions needs."

"Altura continues to supply the maximum flat of service for their valued clientele," talked about Carol Giles Neslund, vice president, North the usa Channel income, Avaya. "The SDS designation is an affirmation that Altura has exhibited a record of success in serving valued clientele and has taken their carrier delivery to the subsequent degree through additional working towards and entry to Avaya world features tools and methodologies."

The Avaya SDS application has 4 areas of designation: Implementation specialist for authorized Avaya channel companions, Implementation expert for services-simplest channel companions, and assist expert and Integration expert for Platinum, Gold, and Silver-certified channel companions. participating channel partners absorb access to Avaya global capabilities and a broad latitude of other Avaya substances to aid them convey a top attribute carrier undergo to consumers.

About Altura

Altura communication options, with places of travail nationwide, is one in every of Avaya's greatest Platinum licensed trade companions and a leading issuer of verbal exchange enabled options and knowledgeable capabilities to enterprises. For pretty much two a long time, enterprises prerogative through North the united states absorb depended on Altura with solving their enterprise concerns. Altura’s commandeer rated and trade main provider, key strategic partnerships providing a complete suite of converged voice and records network options, supply the optimum enterprise cost to their customers.

About Avaya

Avaya is a worldwide chief in commercial enterprise communications programs. The company gives unified communications, contact centers, and related services directly and thru its channel companions to main corporations and corporations around the world. organizations of everything sizes depend upon Avaya for state-of-the-paintings communications that enrich effectivity, collaboration, consumer carrier and competitiveness. For more assistance, delight talk over with http://www.avaya.com.


New Avaya IP workplace supports Equinox | killexams.com true Questions and Pass4sure dumps

June 08, 2018

Avaya has introduced the global availability of a unusual edition of its IP office solution. This unusual release helps Avaya Equinox, the company’s unified communications solution. It furthermore elements ease of employ and administration enhancements targeted at minuscule and medium company clients, and Avaya companions.

“The Avaya IP office retort serves a immense basis – 26 million users and transforming into – and they proceed to fitting the solution in ways that abet organizations capability to be agile and collaborative,” stated Chris McGugan, SVP, solutions and applied sciences, Avaya. “by means of presenting a single app to entry the entire tools they should efficiently talk and collaborate, we’re in reality enabling groups to travail smarter, no longer more durable.”

Avaya IP office addresses a wide selection of communications channels, content material sharing, conferences, and group collaboration. It may furthermore be deployed in the cloud, using the hybrid mannequin, or on premises. Avaya Equinox offers a single, handy to build employ of, contextual interface that’s optimized for everything instruments. It gives one-contact access to calling, messaging, audio and video conferencing, and internet collaboration.

also unusual with the latest version of Avaya IP workplace is a reporting and monitoring package the company got through an oem cope with DevConnect colleague Xima. known as Avaya Chronicall for IP office, the Xima-powered providing provides greater than 50 accustomed plus customizable reports on agent efficiency, visual call administration, and extra. it is accessible for by artery of the cloud and as an on-premises solution.

“As an retort company and intermediary between companies and consumers, it’s vital that we've a list of are animated conversations to build positive that they absorb a reference factor of censorious elements affecting a client’s pride,” spoke of Derek gray, Carousel Cloud solutions specialist. “Chronicall with IP office logs every miniature thing that happens on the name, featuring us with name heritage, recording and true-time reporting, with a clean, convenient to employ interface. This not only provides us with what they want, but is additionally a impeccable wholesome for their consumers.”

This unusual version of Avaya IP workplace furthermore features setting up wizards and management tools. They enable groups and companions to expedite turnup and manage the solution conveniently.

Avaya IP workplace users can entry the retort with Avaya Vantage, the newest J sequence computer telephones for voice and video, and Avaya Equinox soft and cell purchasers.

Edited through Maurice Nagle


Avaya certified specialist (ACS) | killexams.com true Questions and Pass4sure dumps

This vendor-specific Certification is offered by using:AvayaHighlands Ranch, CO USAPhone: 800-288-5327Email: This electronic mail tackle is being included from spambots. You need JavaScript enabled to view it.

skill level: Intermediate                          fame: Being phased out

low-priced: $a hundred twenty five (shortest music)               

abstract:This mid-stage certification is for individuals who combine voice networking, records networking, and purposes into potent trade communications solutions. ACSs design, enforce and abet Avaya options in a true world atmosphere.

preliminary necessities:You must grasp the ACA Certification and circulate one of specialist non-compulsory checks ($one hundred twenty five). pick between two tracks, Design and Implementation.Design Tracks include: Interactive Voice Response programs, IP Telephony, LAN, Messaging, Multimedia Contact facilities and Proactive Contact options.Implementation Tracks include: Interactive Voice Response systems, IP Telephony, LAN, Messaging, Multimedia Contact centers and Proactive Contact options.training is attainable but now not required.

continuing necessities:Certification is legitimate for two years.

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132-S-800-1 Specialist - Messaging Design Elective

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132-S-800-1 exam Dumps Source : Specialist - Messaging Design Elective

Test Code : 132-S-800-1
Test name : Specialist - Messaging Design Elective
Vendor name : Avaya
practice test : 999 true Questions

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Specialist - Messaging Design Elective

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Avaya Certified Specialist (ACS) | killexams.com true questions and Pass4sure dumps

This vendor-specific Certification is Offered By:AvayaHighlands Ranch, CO USAPhone: 800-288-5327Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Skill Level: Intermediate                          Status: Being phased out

Low Cost: $125 (shortest track)               

Summary:This mid-level certification is for individuals who integrate voice networking, data networking, and applications into powerful trade communications solutions. ACSs design, implement and back Avaya solutions in a true world environment.

Initial Requirements:You must hold the ACA Certification and pass one of Specialist Elective Exams ($125). pick from two tracks, Design and Implementation.Design Tracks include: Interactive Voice Response Systems, IP Telephony, LAN, Messaging, Multimedia Contact Centers and Proactive Contact Solutions.Implementation Tracks include: Interactive Voice Response Systems, IP Telephony, LAN, Messaging, Multimedia Contact Centers and Proactive Contact Solutions.Training is available but not required.

Continuing Requirements:Certification is cogent for two years.

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IRIDEX Corporation (IRIX) CEO William Moore on Q3 2018 Results - Earnings call Transcript | killexams.com true questions and Pass4sure dumps

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Top 10 Takeaways: 2019 Medicare Physician Fee Schedule | killexams.com true questions and Pass4sure dumps

Tuesday, November 6, 2018

On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released the CY 2019 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare partake B [CMS-1693-F] Final Rule, which includes policy changes related to Medicare physician payment and the attribute Payment Program (QPP). The final rule furthermore implements provisions of the Bipartisan Budget Act of 2018 (BBA) and addresses policies related to the Medicare Shared Savings Program (MSSP), Medicare partake B drugs, commandeer employ Criteria and the laboratory fee schedule, among other topics. It will be published in the Federal Register on November 23, 2018. Comments solicited on positive provisions of the Final Rule are due on December 31, 2018.

A topline summary of the major provisions follows.

2019 Medicare Physician Fee Schedule Changes

In the 2019 Physician Fee Schedule (PFS) Final Rule, CMS continues to emphasize the themes of providing regulatory and administrative relief for clinicians, modernizing payment policies to promote services such as virtual care, and saving Medicare beneficiaries’ time and money while improving their access to high-quality services. CMS projects that the rule will reclaim clinicians $87 million in reduced administrative costs in 2019 and $843 million over the next decade.

1. 2019 Medicare Physician Conversion Factor Remains Essentially Flat

√ The 2019 Medicare Physician CF is $36.0391.

The 2019 final physician conversion factor (CF) is $36.0391, a slight expand from the 2018 PFS CF of $35.9996. The 2019 anesthesia CF is $22.2730, a slight expand from the 2018 anesthesia CF of $22.1887.

The 0.50 percent update specified by the Medicare Access and CHIP Reauthorization Act (MACRA) was reduced to 0.25 percent as a result of a provision in the BBA of 2018. The CF was then further reduced by a relative value unit (RVU) budget neutrality adjustment (-0.14 percent). In addition, in 2019, Merit-Based Incentive Payment System (MIPS) eligible clinicians’ Medicare fee-for-service (FFS) payments will be affected by their 2017 MIPS performance, which by statute, was scheduled to palpate 2019 Medicare payments by +/- 4 percent. Yet, due to budget neutrality adjustments, it is expected that the top positive MIPS 2019 adjustment, with the inclusion of the exceptional performance bonus, will be just below 2 percent.

MIPS is a budget-neutral program. This means that the dollar amounts for positive and negative payment adjustments must equipoise out. CMS clarified in the final rule that the reduction from the maximum positive adjustments set forth by statute is the result of where the agency has set the MIPS performance threshold. The MIPS performance threshold represents the score that is necessary to receive a neutral to positive payment adjustment for the year. For 2017, clinicians needed three out of 100 points to avoid a negative payment adjustment. The agency stated that if it had set a higher performance threshold, there would absorb been more dollars available for positive payment adjustments.

Physician payment is based on the application of the dollar CF to work, exercise expense (PE) and malpractice RVUs, which are then geographically adjusted. PE RVUs capture the cost of supplies, rig and clinical personnel wages used to accouter a specific service. CMS finalized a proposal to update input prices for supplies and rig based upon a large survey conducted by a market research hard under constrict to CMS. CMS will phase in these unusual inputs over a four-year age genesis in 2019. These supply and rig prices were eventual systematically developed in 2004–2005. Based on public comments, CMS revised inputs for several items from what was originally proposed based on the contractor’s findings. These changes are summarized in Table 9 of the final rule.

2. Proposed E/M Overhaul Scaled Back and Delayed

√ CMS delays changes to the coding and payment structure for E/M services until 2021, but will implement several documentation policies in 2019.

For 2019, CMS originally proposed sweeping changes to evaluation and management (E/M) payment and documentation requirements, including creation of a single payment for flat 2–5 office codes and significantly reduced documentation requirements. In this final rule, CMS delays changes to the coding and payment structure for E/M services until 2021, but implements several documentation policies in 2019.

Because E/M services build up approximately 40 percent of allowed charges under the PFS (office/outpatient E/M services comprise approximately 20 percent of allowed charges), any changes would absorb a wide-ranging impact across different specialties. For years, there has been significant concern around the complexity and burden of documenting E/M services. While the proposal for reductions in documentation requirements was generally welcomed, CMS faced significant criticism from the provider community on the proposal for a single payment for flat 2–5 E/M codes. Letters requesting withdrawal of the proposal signed by a coalition of 170 groups were submitted to both congressional leadership and CMS.

CMS finalized the following policies for 2019:

  • Removed the need to justify providing a home visit instead of an office visit

  • Changed the required documentation of the patient’s history to focus only on the interval history since the previous visit

  • Eliminated the requirement for physicians to re-document information already documented in the patient’s record by exercise staff or by the patient

  • CMS furthermore declined to stagger forward on a proposal to reduce payment for office visits when performed on the very day as another service. Nor did CMS establish sever coding and payment for podiatric E/M visits.

    CMS finalized the following payment and coding policies but delayed implementation until 2021:

  • Reduction in the payment variation for E/M office/outpatient visit levels by paying a single rate for E/M office/outpatient visit levels 2 through 4 for established and unusual patients while maintaining a higher payment rate for E/M office/outpatient visit flat 5

  • Implementation of several changes allowing greater flexibility and reduced burden in documentation, including allowing clinicians to employ medical decision-making or time instead of applying the current 1995 or 1997 E/M documentation guidelines

  • Implementation of add-on codes that picture the additional resources inherent in visits for primary keeping and particular kinds of non-procedural specialized medical keeping (not specialty-specific; reported with flat 2–4 codes; generally would not impose unusual documentation requirements)

  • Adoption of a unusual “extended visit” add-on code for employ only with E/M office/outpatient flat 2 through 4 visits to account for the additional resources required when practitioners need to expend extended time with the patient

  • CMS posted a chart on E/M payment amounts here.

    3. CMS Makes Historic Change by Establishing Payment for Virtual Check-Ins and Other Technology-Based Services

    √ CMS finalizes sever payment for multiple communication-technology-based services that would not be matter to the limitations placed on Medicare telehealth services.

    In establishing payment for services utilizing technology-based services, CMS acknowledges that recent innovations in health keeping absorb given rise to the progress of services that inherently require the employ of communication technology but upshot not necessarily fitting into the telemedicine category. In the 2019 PFS Final Rule, CMS establishes payment for a discrete set of services that are defined by and inherently involve the employ of communication technology.

  • Brief Communication Technology-Based Service,g., Virtual Check-In (HCPCS code G2012): This code describes brief check-in services furnished using communication technology that are used to evaluate whether an office visit or other service is warranted. This service would be limited to established patients, and verbal consent is preeminent in the medical record for each billed service. If the service originates from a related E/M service provided within the previous seven days by the very physician or other qualified health keeping professional, or leads to an E/M service, it would be considered bundled and not separately billable.

  • Remote Evaluation of Pre-Recorded Patient Information (HCPCS code G2010): This code describes physician employ of recorded video and/or images captured by a patient in order to evaluate a patient’s condition. The follow-up with the patient could hoist region via phone call, audio/video communication, secure text messaging, email or patient portal communication. This is a stand-alone service that could be separately billed to the extent that there is no resulting E/M office visit and there is no related E/M office visit within the previous seven days of the remote service being furnished. This service would be limited to established patients, and verbal consent is preeminent in the medical record for each billed service.

  • Interprofessional Internet Consultation (CPT codes 99446, 99447, 99448, 99449, 99451 and 99452): These codes picture interprofessional consultations (between the treating practitioner and a consulting physician or a qualified health keeping professional) performed via communications technology such as telephone or internet. The patient’s verbal consent is required for these services. These interprofessional services may be billed only by practitioners that can bill Medicare independently for E/M services.

  • CMS furthermore finalized policies to pay separately for unusual coding describing chronic keeping remote physiologic monitoring (CPT codes 99453, 99454 and 99457).

    Additionally, CMS finalized changes to its Medicare telehealth services list:

  • Adding HCPCS codes G0513 (Prolonged preventive service(s) beyond the typical service time of the primary procedure, first 30 minutes) and G0514 (Prolonged preventive service(s) beyond the typical service time of the primary procedure, each additional 30 minutes) to the Medicare telehealth list

  • Implementing a provision in the BBA of 2018 to expand access to home dialysis therapy through telehealth and expand access to individuals with stroke

  • Expanding Medicare Telehealth Services for the Treatment of Opioid employ Disorder and Other gist employ Disorders

  • 2019 QPP Changes

    Beginning in 2019, eligible clinicians (including most physicians) will be paid for Medicare partake B services under the unusual QPP (based on 2017 reporting activities), and they will continue to elect either to be matter to payment adjustments based upon performance under the MIPS or to participate in the Advanced Alternative Payment Model (APM) track. Eligible clinicians choosing the MIPS pathway will absorb payments increased, maintained or decreased based on relative performance in four categories: quality, employ of information technology, clinical improvement activities and cost. Eligible clinicians choosing the Advanced APM pathway will automatically receive a reward payment once they meet the qualifications for that track.

    This year’s QPP rulemaking continues the ramp-up for MIPS-participating clinicians, with CMS expanding the number of clinicians included in MIPS, increasing the threshold score for avoiding a MIPS penalty and increasing the weight of the MIPS cost component. Advanced APM track policies remained fairly stable, with some modest policy changes intended to streamline the program and reduce burden for participants. CMS furthermore indicated that in response to feedback from stakeholders, it has begun a succession of strategic planning sessions to assess the current value of the program for clinicians and beneficiaries alike and to implement the program in a artery that is understandable to beneficiaries.

    4. CMS Expands the Number of Clinicians Eligible to Participate in MIPS

    √ CMS estimates 798,000 MIPS-eligible clinicians for the 2019 MIPS Performance Period.

    CMS estimates that approximately 798,000 clinicians will be MIPS-eligible clinicians in the 2019 Performance Period, an expand of almost 148,000 from the evaluate provided in the proposed rule. The number furthermore represents an expand from the 2018 Final Rule, in which CMS estimated that approximately 622,000 clinicians would be MIPS eligible for the 2018 MIPS Performance Period. This change is driven by an expansion in the types of health keeping professionals eligible to participate in MIPS, a change in the Low Volume Threshold Exception and a unusual finalized MIPS opt-in policy.

    Currently eligible clinician types comprehend physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and groups that comprehend such professionals (required by statute). Consistent with the MACRA statute, CMS is expanding participation in MIPS to include: physical therapists, occupational therapists, qualified speech-language pathologists, qualified audiologists, clinical psychologists, and registered dieticians or nutrition professionals. CMS estimates that this change will expand the pool of MIPS-eligible clinicians by 20,240.

    The Low Volume Threshold (LVT) excludes positive clinicians and groups from participating in MIPS. In 2019, CMS adds a third criterion to the low volume exclusion test that would be based on the number of covered professional services provided. Per the 2019 LVT policy, to be excluded from MIPS, clinicians or groups will need to meet one of the following three criteria: absorb ≤ $90,000 in partake B allowed charges for covered professional services, provide keeping to ≤ 200 beneficiaries or provide ≤ 200 covered professional services under the PFS. CMS estimates that this proposed 2019 policy will remove an additional 1,165 MIPS-eligible clinicians in comparison to the 2018 LVT policy.

    Finally, CMS will implement a MIPS opt-in policy for the first time in 2019. Starting in Year 2019, clinicians or groups would be able to opt in to MIPS if they are exempt from MIPS based upon one or two, but not everything three of the LVT criteria. CMS estimates an additional 27,903 MIPS-eligible clinicians as a result of this policy.

    5. CMS Doubles Minimum Score Necessary to Avoid a Negative MIPS Adjustment

    √ MIPS Performance threshold increases from 15/100 points to 30/100 points.

    The “performance threshold” represents the score that is necessary to receive a neutral to positive payment adjustment for the year. A score below the performance threshold will result in a negative payment adjustment, while a score above the payment threshold will result in a positive payment adjustment. A score at the payment threshold will result in a neutral payment adjustment.

    MACRA authorized an additional $500 million each year from 2019 to 2024 to award “exceptional performance” bonuses to MIPS providers with the highest composite performance scores. CMS sets a sever exceptional performance threshold to award these higher payment adjustments. For 2019 CMS has finalized the following policies:

    6. CMS Increases the Weight of the Cost Component in MIPS Final Score

    √ Weight of Cost Performance Category on MIPS final score increases from 10 to 15 percent in 2019.

    The MIPS final score is based on performance in four categories: Quality, Promoting Interoperability (previously known as Advancing keeping Information), Improvement Activities and Cost. For 2019, CMS will expand the weight of the Cost Performance Category for the final MIPS score from 10 percent (2018) to 15 percent (2019). This change results in the following allocations of the four performance categories for the 2019 Payment Year: attribute (45 percent), Promoting Interoperability (25 percent), Improvement Activities (15 percent) and Cost (15 percent).

    Currently the Cost Performance Category is based on two measures: Total Per Capita Cost and Medicare Spending Per Beneficiary. In the final rule, CMS is adding eight recently developed episode-based cost measures: Elective Outpatient Percutaneous Coronary Intervention (PCI), Knee Arthroplasty, Revascularization for Lower Extremity chronic censorious Limb Ischemia, Routine Cataract Removal with Intraocular Lens (IOL) Implantation, Screening/Surveillance Colonoscopy, Intracranial Hemorrhage or Cerebral Infarction, Simple Pneumonia with Hospitalization, and ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI).

    7. Meaningful Measures Initiative Drives Changes to build attribute Reporting More Meaningful and Less Burdensome

    √ Changes comprehend deletion of attribute measures, revision of the definition of high-priority measures and implementation of facility-based reporting.

    The Meaningful Measures Initiative launched in October 2017 with the point of identifying the highest priority areas for attribute measurement and attribute improvement to foster the agency’s travail to improve patient outcomes. Since then, CMS has been reviewing attribute measures across Medicare and Medicaid under the lens of this initiative. CMS has furthermore indicated that as partake of its review, it is considering whether collecting information is valuable to clinicians and whether it is worth the cost and resources. For the 2019 MIPS Performance Period, CMS will add eight unusual attribute measures and remove 26 current attribute measures. Stakeholders absorb raised concerns about the number and pace of attribute measures being removed from the program. They absorb urged CMS to ensure there are a adequate number of meaningful measures available for various specialties to participate in MIPS.

    In response to the opioid epidemic across the United States, CMS revises the definition of a high-priority measure to comprehend attribute measures that relate to opioids and to further clarify the types of outcome measures that are considered elevated priority. CMS is defining high-priority measure to intend an outcome, commandeer use, patient safety, efficiency, patient experience, keeping coordination or opioid-related attribute measure.

    CMS will implement facility-based scoring for 2019, whereby facility-based clinicians can employ their facility’s Hospital Value-Based Purchasing score as a proxy for their attribute and Cost Performance Category scores. The clinician or group must meet the definition of facility-based finalized in this rule to be eligible for this option.

    8. CMS Maintains Stable Advanced APM and Other Payer Advanced APM Options

    √ The agency finalizes relatively minor proposals, continuing Advanced APM implementation.

    CMS proposed several updates to the Advanced APM and Other Payer Advanced APM options. genesis with the 2019 performance year, eligible clinicians either employ their

    Advanced APM participation in traditional Medicare lonesome or can combine their participation in traditional Medicare Advanced APMs with participation in other payers’ Advanced APM models to qualify for the Advanced APM 5 percent payment bonus. CMS proposed several relatively minor modifications to the qualifying criteria. In general, CMS finalized its proposals, including:

  • Increasing the requirement related to employ of certified electronic health records technology (CEHRT) from 50 percent of eligible clinicians in each advanced APM entity in 2018 to 75 percent of eligible clinicians in each APM entity in 2019

  • Maintaining the generally applicable nominal amount criterion (one measure of the amount of risk an APM bears to fill the requirement that risk be in excess of a nominal amount) through 2024

  • Allowing payers and eligible clinicians seeking approval of Other Payer Advanced APMs to submit evidence that CEHRT is used by the requisite percentage of eligible clinicians (50 percent in 2019 and 75 percent in 2020) in the arrangement (as opposed to requiring specific documentation in the terms of the payment arrangement)

  • Adding a third alternative to allow qualifying participant determinations at the TIN flat (in addition to the eligible clinician and APM entity levels) for Other Payer Advanced APMs in positive circumstances

  • The regulatory changes in the final rule maintain relatively stability in the Advanced APM and Other Payer Advanced APM landscape. However, complexity and the limited options for participation persist. For example, so far, CMS has approved only a handful of Other Payer Advanced APMs nationwide: six Medicaid arrangements and two multi-payer initiatives. The pace of Advanced APM progress on the traditional Medicare side has similarly slowed.

    9. CMS Finalizes Time-Sensitive Provisions from MSSP Proposed Rule

    √ 2016 ACO starters will absorb an optional six-month extension from January 1 through June 30, 2019.

    In August 2018, CMS issued the Medicare Program: Medicare Shared Savings Program (MSSP); Accountable keeping Organizations – Pathways to Success proposed rule, which proposed fundamentally to restructure the MSSP. In the PFS final rule, CMS finalizes positive time-sensitive provisions from the proposed rule. The leisure of the MSSP proposed rule provisions will be addressed in a subsequent rulemaking.

    Notably, CMS offers a willful six-month extension for existing MSSP ACOs whose participation agreements expire December 31, 2018. This was necessary because CMS proposes to start the unusual Pathways to Success MSSP on July 1, 2019 rather than January 1, 2019. Without this extension, MSSP ACOs that started in 2016 would absorb faced a six-month gap period. CMS furthermore finalized the methodology for determining financial and attribute performance for the six-month extension period.

    In this final rule, CMS furthermore finalizes modifications to the definition of primary keeping services used in assigning beneficiaries to ACOs to reflect recent code changes, implements positive BBA 2018 provisions on willful alignment which allows ACO beneficiaries to designate a clinician answerable for their care, provides relief for clinicians affected by extreme and uncontrollable circumstances, and makes positive revisions to the program to promote interoperability among ACO providers and suppliers to align with the QPP.

    CMS furthermore finalized a number of changes to the MSSP attribute program, including the elimination of nine measures and the addition of two for the MSSP attribute measure set, resulting in a set of 23 measures on which ACO attribute performance will be assessed in 2019.

    10. CMS Finalizes MAQI Demo, Rejects PTAC Recommended Models

    √ MAQI demonstration qualifies participants for a MIPS exemption, but not a 5 percent bonus. CMS is unlikely to implement approved PTAC models in their entirety.

    The agency finalized its proposal to implement the MAQI demonstration project using its waiver authority to waive positive requirements for participating clinicians. Clinicians participating in this demonstration may employ their risk contracts in Medicare edge in combination with Advanced APMs to receive an exemption from MIPS reporting and payment consequences. Stakeholders had requested that clinicians participating in this model furthermore receive the 5 percent Advanced APM incentive payment. CMS responded that including a reward payment would add significant costs to CMS without adequate evidence that the demonstration could reclaim an equal or greater amount of money. Therefore, the agency declined to incorporate reward eligibility in the MAQI demonstration. CMS states that it will collect MAQI-related information in 2018, and eligible clinicians will be exempt from MIPS adjustments in 2020.

    As preeminent in their analysis of the proposed rule, CMS was silent on the topic of the Physician Focused Payment Model Technical Advisory Committee (PTAC). In the final rule, CMS preeminent that many commenters asked that CMS implement and test PTAC-recommended models. CMS responded that while it “seems unlikely that everything of the features of any PTAC-reviewed proposed model will be tested exactly as presented in the proposal, positive features of proposed models may be incorporated into unusual or existing models.” CMS furthermore indicates that it will continue to travail with stakeholders to design and implement unusual APMs.

    The pace of progress of unusual models has been modest. Many stakeholders will be closely watching the hub for Medicare and Medicaid Innovation over the next several months and the first quarter of 2019 in anticipation of a direct contracting model and other Advanced APM options.

    Directionally, the Trump Administration continues to pursue policies that relieve administrative burden and streamline health keeping regulations and policies. Stakeholders were relieved that

    CMS backed off of a proposed sweeping reform to payment for E/M services. However, downward pressure on payment rates is likely to continue in future rulemaking.

    The Administration continues to foster implementation of the QPP, with modest ramping up of various requirements in both the MIPS and the Advanced APM tracks. The pace of implementation of unusual Advanced APM options continues to be slow, with unusual models anticipated between now and the quit of the first quarter of 2019.



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