ACA (Affordable Care Act) – The comprehensive health care reform law enacted in March 2010. It is officially called the Patient Protection and Affordable Care Act, but it is also known as “Obamacare.”

ACI (Advancing Care Information)-  Previously known as Meaningful Use; addresses the technological aspects of MIPS.

ACO (Accountable Care Organization) – Health care providers, doctor groups, and hospitals who provide high quality care to Medicare patients.

APM (Alternative Payment Models)- Type of payment intended to report current payment systems that focus on quality and total costs rather than the old traditional fee-for-service structure used previously.

  • Advanced APM – Not all APMs will qualify as “advanced.” In order to be considered an “Advanced APM” the following criteria must be met:  it must meet the legislative definition of an APM, at least 50% of participants must use a certified EHR, payment must be based on quality measures comparable to those used in MIPS (of which one must be an outcome measure), and it must  bear more than nominal financial risk (or is a CMMI Medical Home Model expanded by the Secretary of DHHS).

  • MIPS APM – Certain APMs include MIPS eligible clinicians as participants and hold their participants accountable for the cost and quality of care provided to Medicare beneficiaries. This type of APM is called a “MIPS APM,” and participants in MIPS APMs receive special MIPS scoring under the “APM scoring standard.”

CAHPS (Consumer Assessment of Healthcare Providers and Systems)- A survey, conducted each year since 1995 that rate health care experiences in the United States. The results are made public and used by the Medicare system to determine Diagnostic Related Group payment for a hospital.

CEC (Comprehensive ESRD Care Model) – A type of care model that was made to test, identify, and evaluate alternative ways to raise the threshold of care for Medicare beneficiaries with End-Stage Renal Disease or ESRD.

CHIP (Children’s Health Insurance Program) – A source of medical coverall for people who are under the age of 19 what have parents that may earn too much income to typically qualify for Medicaid, but not enough for private insurance. CHIP plans can vary start to state, but can cover: immunizations, doctor visits, prescriptions, dental care, and emergency services.

CMMI (Center for Medicare and Medicaid Innovation)- An organization created under the Affordable Care Act and Patient Protection Act to test new payment and delivery system models that can help in improving the CHIP, Medicaid, Medicare and quality of care while lowering overall costs of those programs.

CMS (Centers for Medicare and Medicaid Services) - a federal agency within the HHS that administers the Medicare program and works in partnership with state governments to administer Medicaid, SCHIP, and health insurance and portability standards. CMS has other responsibilities including the administrative simplification standards from HIPAA, the oversight of HealthCare.gov., and more

CPCI (Comprehensive Primary Care Initiative) – A partnership between with Medicare and other programs aims to encourage primary care providers to provide additional resources that result in improvements to quality of care.

CPC+ (Comprehensive Primary Care Plus) – Announced in April 2016, this is a new patient-centered, value-based, multi-payer primary care model. It seeks to focus on ways to patient centered care that promoted population and chronic disease management.

CPS (Composite Performance Score) – The total score from each category of MIPs (Quality+ Improvement Activities + Advancing Care Information +Cost).

CQM (Clinical Quality Measure)- Required under MIPS, CQM are the tools use to help track the clinical quality for providers using a certified EHR or qualified clinical data registry (QCDR).  

  • Cross-Cutting Measure – These are measures that apply across all specialties, such as height and weight or medication reconciliation.

  • Outcome Measure – As indicated, these measure outcomes as opposed to processes.

EC (Eligible Clinician, formerly EP or eligible professional)- The term used to describe clinicians/providers that are qualified to participate, with eligibility being defined by each program.

EHR- Electronic Health Record

FFS- Fee for Service The way traditional Medicare services are paid for. \

FQHC- Federally Qualified Health Centers

HHS- United States Department of Health and Human Services

HIPPA- Health Insurance Portability and Accountability Act

HPSA- Health Professional Shortage Areas

IA (Improvement Activities) – Previously known as “Clinical Practice Improvement Activities or CPIA.” IA are used as one facet for the total MIPS Performance Score. Improvement activities can include, behavioral health integration, patient safety and practice assessment, population management, and expanded practice access.

MACRA (Medicare Access and CHIP Reauthorization Act of 2015) – The law that starting in 2019 will replace the Sustainable Growth Rate Model with a value-based system with the goal of creating a different more sustainable payment system for providers and physicians.

MIPS (Merits-based Incentive Payment System) -  A path that will be based on practice improvement, costs, technology and quality. Meaningful use, physician quality reporting system, and the value based modifier will be consolidated into MIPS starting in 2019.

MIPS Composite Score- The Merit-based Incentive Payment System score for year one that will be based on 4 categories that will be called a Composite Performance Score: Resource Use or Cost (0%), Improvement Activities (15%), Advancing Care Information (25%), and Quality (60%).

MSSP (Medicare Shared Savings Program)- MSSP, initiated by the Affordable Care Act aims to improve value of care by lowering growth in erroneous costs, better health for the general populations, and better health care for individuals. Accountable Care Organizations that decrease costs and meet performance standards will be rewarded by the Share Savings Program.

MU (Meaningful Use) – Defined as the use of EHR technology to: maintain privacy and security of patient health information, improve the coordination of care, to engage patients and family, and improve safety, efficiency, and quality while reducing health disparities. This program was set up in three stages over the next 5 years:

  • (2011-2012)- Stage 1: Data capture and sharing

  • (2014)- Stage 2: Advance clinical processes

  • (2016) Stage 3: Improved outcomes

NPI (National Provider Identifier)- A unique 10-digit identification number issued to health care providers in the United States by CMS

OCM- Oncology Care Model

PCMH- Patient-Centered Medical Home

PFS- Physician Fee Schedule

PQRS (Physician Quality Reporting System)- Previously known as the Physician Quality Reporting Initiative (PQRI), PRQS is a program that encouraged providers and eligible professionals to report on quality of care through financial rewards.

QCDR- Qualified Clinical Data Registries

QIN-QIO- Quality Innovation Networks- Quality Improvement Organizations

QP (Qualified Professional)- The name of the providers or professionals that will participate in Advanced APMS.

QPP (Quality Payment Program)- Payment program that will be used to implement MACRA in the proposed rule to be released April 27, 2016.

QRUR (Quality and Resource Use Report)- Introduced with PQRS in 2014, it is a CMS approved “entity that collects medical and/or clinical data for the purpose of patient and disease tacking to foster improvement in the quality of care provided to patients.”1 Providers must nominate themselves and complete and application.

RHC- Rural Health Clinic

SGR (Sustainable Growth Rate)- A formula used to base Medicare Part B payments through 2017. This is the payment system that MACRA will replace.

SURS (Small, Underserved, and Rural Support)-  A program created by the passage of MACRA that seeks to provide direct technical assistance to help MIPs eligible clinician and small practices participate in the Quality Payment Program. The program will be comprised of local, experienced organizations that will help clinicians in small and rural practices do four things:

  • Select and report on appropriate measures and activities to satisfy the requirements of each performance category under MIPs.

  • Optimize their health information technology.

  • Engage in continuous quality improvement.

  • Evaluate their options for joining and Advanced Alternative Payment Model.

TCPI (Transforming Clinical Practice Initiative)- Designed to help clinicians achieve large-scale health transformation through sharing, adapting, and developing their comprehensive quality improvement strategies with the support of more than 140,000 practices.

TIN (Tax Identification number) – This number, which identifies the billing entity, is used to connect each eligible clinician which is then used to calculate APM participation and MIPS scores.

VBP/VBMP/VM (Value-based payment modifier)- “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”

Sources:

1. Quality Clinical Data Registry Reporting - www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/pqrs/qualified-clinical-data-registry-reporting.html

Entnet.org. “Alternative Payment Models”- www.entnet.org/content/alternative-payment-models

ACPOnline- “MACRA Glossary of Acronyms and Terms”- /www.acponline.org/practice-resources/business-resources/payment/medicare/macra/macra-glossary-of-acronyms-and-terms