As if a new proposed 900-page rule for Medicare Access and CHIP Reauthorization Act (MACRA) hasn’t caused enough confusion, the acronyms and abbreviations alone could send someone to the z-o-o. CMS has officially announced that the rule is set to be finalized by November 1, 2017. We have put together a glossary and list of acronyms to arm you as you continue to research and educate yourself in the next few months on the complex rule and how it will affect you.
ABC™: Achievable Benchmark of Care
ACA: The Patient Protection and Affordable Care Act. Officially called the Patient Protection and Affordable Care Act of 2010, and also known as “Obamacare,” this massive legislation effective included many parts, some of which are defined herein.
ACI: Advancing Care Information. The component of MACRA that will include what was formerly known as Meaningful Use. It covers the technological aspects of MIPS. Read more about Advancing Care Information here.
ACO: Accountable Care Organization. A group of doctors, hospitals and other health care providers who voluntarily work with one another to give coordinated high quality care to their Medicare patients. The goal is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. Certain ACOs participating in CMS programs may qualify as an APM or Advanced APMs if they meet the criteria.
APM: Alternative Payment Model. Represent new approaches to paying for medical care of Medicare patients that incentives quality and value. So far there is not an abundance of clarity in regards to the definitions and flexibility in types of APMs.
BPCI: Bundled Payments for Care Improvement
CAH: Critical Access Hospital
CAHPS: Consumer Assessment of Healthcare Providers and Systems. A survey that measures patient experience per provider. Voluntary
participating in CAHPS for MIPS surveys would count as a cross-cutting or patient experience measure for Quality scoring purposes.
CEHRT: Certified EHR technology.
CFR: Code of Federal Regulations
CHIP: Children’s Health Insurance Program. This program provides health coverage to eligible children, both through Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements and is funded jointly by states and the federal government.
CJR: Comprehensive Care for Joint Replacement
CMMI: Center for Medicare & Medicaid Innovation (Innovation Center)
CPIA: Clinical Practice Improvement Activity. One component of the total MIPS Composite Score, and new to physician reporting. There are over 90 proposed activities from which practices can choose to implement. Some of the categories include expanded practice access, population management, care coordination, beneficiary engagement, patient safety and practice assessment,
emergency preparedness, and behavorial health integration. Read more about CPIA here.
CPC+: Comprehensive Primary Care Plus. CPC+ is a five-year model that will begin in January 2017 and replaces CPC Classic. CPC+ is a national advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation. CPC+ will include two primary care practice tracks with incrementally advanced care delivery requirements and payment.
CPR: Customary, Prevailing, and Reasonable
CPS: Composite Performance Score. The sum of the four MIPS categories – Quality, Resource Use, Advanced Care Information and CPIA. It was previously referred to as the MIPS Composite Score.
CPT: Current Procedural Terminology
CQM: Clinical Quality Measure. CQMs measure and track quality of services provided by ECs. They measure aspects of patient care, including health outcomes, clinical processes, patient safety, efficient use of resources, care coordination, patient engagement, population health, and adherence to clinical guidelines.
EC: Eligible Clinician. This term was formerly known as EP or eligible professional, used to indicate which professionals are qualified to participate in government reporting and incentive programs. “Eligible” is defined by each program, and the types of clinicians eligible to report under MIPS and MACRA will likely be extended in the future. Read more about who qualifies for MIPS here.
EHR: Electronic Heath Record
EP: Eligible professional
FFS: Fee-for-Service. Most Medicare payments are based on services provided. Traditional Medicare (Part B) is based on FFS payments. MACRA is an effort to transition away from FFS.
FQHC: Federally Qualified Health Center
HIE: Health Information Exchange
HIPAA: Health Insurance Portability and Accountability Act of 1996
HITECH: Health Information Technology for Economic and Clinical Health
HPSA: Health Professional Shortage Area
HHS: Department of Health & Human Services
HRSA: Health Resources and Services Administration IT Information technology
MACRA: Medicare Access and CHIP Reauthorization Act of 2015
MEI: Medicare Economic Index
MIPAA: Medicare Improvements for Patients and Providers Act of 2008
MIPS: Merit-Based Incentive Payment System. On of two tracks through which providers will participate in MACRA. This path will pay based on quality, technology, resource use (cost) and practice improvement. PQRS, MU, and VBM will be folded into one program under MIPS.
MLR: Minimum Loss Rate
MSPB: Medicare Spending per Beneficiary
MSR: Minimum Savings Rate
MUA: Medically Underserved Area
NPI: National Provider Identifier
OCM: Oncology Care Model
ONC: Office of the National Coordinator for Health Information Technology
PCMH: Patient-Centered Medical Home. The PCMH is a model of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible and focused on quality and safety. Read more about implementing a PCMH and the benefits here.
PECOS: Medicare Provider Enrollment, Chain and Ownership System
PFPMs: Physician Focused Payment Models
PFS: Physician Fee Schedule
PHS: Public Health Service
PQRS: Physician Quality Reporting System. PQRS is a quality reporting program that encourages individual eligible professionals (EPs) and group practices to conduct industry-recognized quality measures and report them to CMS. Monetary incentives and penalties are attached to this program. PQRS will be folded into the quality component of MIPS. Read more about PQRS here.
QCDRs: Qualified Clinical Data Registries
QP: Qualifying APM Professional
QPP: This is the name of the new payment program to implement MACRA in the proposed rule released on April 27, 2016.
QRDA: Quality Reporting Document Architecture
QRUR: Quality and Resource Use Reports
RBRVS: Resource-Based Relative Value Scale
RHC: Rural Health Clinic
RVU: Relative Value Unit
SGR: Sustainable Growth Rate. This is the formula on which fee-for-service Medicare Part B payments are based through 2017. This payment system is effectively replaced by MACRA (MIPS and APM).
TCPI: Transforming Clinical Practice Initiative. This is an initiative within CMMI that is designed to help practices achieve large-scale health transformation so that they can participate in APMs. The initiative is designed to support practices over the next four years in sharing, adapting and further developing their comprehensive quality improvement strategies.
TIN: Tax Identification Number
VM: Value-based Payment Modifier. This program provides differential payment to a physician or group under the Medicare Physician Fee Schedule (PFS) based upon the quality of care furnished compared to the cost of care during a performance period. VM will also be consolidated into MIPS.
VPS: Volume Performance Standard