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  #51  
Old 03-11-2019, 12:24 PM
scott.ac scott.ac is offline
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is anyone else struggling to understand the difference/overlap between ACOs and MIPS in the MSSP? I think the ACOs make sense on their own, but I am getting mixed up when trying to think about how MIPs works and how ACOs fit into that system.
I've struggled with this also; I found this website that gives more detail than the slideshow (http://us.milliman.com/insight/2016/...cipant-status/). From that, I think:

Nearly all clinicians are initially subject to MIPS
Outside of an ACO, individual providers report MIPS
If in a 1-sided ACO, the whole ACO calculates an aggregate MIPS that all providers use
If in a 2-sided ACO, the whole ACO reports quality measures instead of (or same as, not sure) MIPS. You are exempt from MIPS and get advanced APM adjustments instead of MIPS adjustments.
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  #52  
Old 03-12-2019, 05:08 PM
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thanks for that summary. The source material is just a power point deck (which does not flow very well. Prob supposed to be used for a presentation as opposed to just reading the deck). I think they are trying to show how ACOs are related to MIPS. I dont think we need to know how to calculate MIPS measures/payments though.

My notes on 1 sided ACOs are the same as yours. for 2 sided I added notes that the ACO will receive 5% lump sum incentive for participating in a AAPM, are excluded from MIPS reporting, and will get a better FFS increase in 2026. There is a % of patients/payments needed to get these incentives.

I think Im done looking at this section. feels like a waste of time...
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  #53  
Old 03-14-2019, 12:19 AM
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Anyone else buy the Condie Online Seminar and wondering when the "upcoming 3/19" videos will actually become available?

Seems like the Amazon-Berkshire-Chase merger came up with a company name faster than the amount of time going into these dang videos.
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  #54  
Old 03-14-2019, 10:37 AM
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Just officially registered for the exam. Really hoping I can push through my hatred of studying and pass this dang thing.
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I would really hate to bring Pokémon to a gun fight.
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  #55  
Old 03-17-2019, 11:33 AM
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any idea when they changed the weights for the ACO benchmark from 10/30/60 to 33/33/33?

Looking at the fall 18 exam and the sample solutions still reference the old weighting method.
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  #56  
Old 03-17-2019, 12:32 PM
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also note for anyone practicing on the fal18 exam, most of #12 is related to duncan chapter 14 which was removed from the syllabus.
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  #57  
Old 03-17-2019, 02:17 PM
MATEseminars.dc MATEseminars.dc is offline
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Default ACO benchmark weights

There is material added to the syllabus for the spring 2019 sitting that briefly discusses the new weights. In the New Duncan book in section 22.7.2 he mentions that in a 2015 rule, "CMS equally weights the previous three historical benchmark years during the second and subsequent 3-year agreement periods."

Basically the first (3 year) agreement period will continue to use the 60-30-10 rule to weight the benchmark. In the second and subsequent agreement periods the weights will equal for all 3 benchmark years.

I interpenetrated this as, to be effective after the 2015 rule meaning effective in 2016, I have also read other CMS documents that say the new reweighing method is effective as of 2016.

Good luck!
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  #58  
Old 03-17-2019, 03:18 PM
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Originally Posted by MATEseminars.dc View Post
There is material added to the syllabus for the spring 2019 sitting that briefly discusses the new weights. In the New Duncan book in section 22.7.2 he mentions that in a 2015 rule, "CMS equally weights the previous three historical benchmark years during the second and subsequent 3-year agreement periods."

Basically the first (3 year) agreement period will continue to use the 60-30-10 rule to weight the benchmark. In the second and subsequent agreement periods the weights will equal for all 3 benchmark years.

I interpenetrated this as, to be effective after the 2015 rule meaning effective in 2016, I have also read other CMS documents that say the new reweighing method is effective as of 2016.

Good luck!
Yikes, i misread that on the first pass to be the first intervention period weights changing. going back, it does seem to ONLY apply to the 2nd/3rd periods (so the initial program benchmark is still 10/30/60).

I was wondering why they had that chapter on unintended consequences...

Page 44 of the mate manual if anyone was curious about this.
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  #59  
Old 03-19-2019, 12:22 PM
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When a Stop Loss (SL) insurer purchases specific SL insurance, is that insurance usually at the claim level instead of the member level?

I'm referring specifically to MATE practice problem #12, where an employer buys Spec and Agg SL from an insurance company, who then turns around and purchases Spec SL from a company named "Retrocede, Inc". You have to calculate the SL payments. I did it right for the employer to the first SL company, but not from the first insurer to the second insurer.
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I would really hate to bring Pokémon to a gun fight.
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  #60  
Old 03-20-2019, 11:01 AM
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Another MATE question, practice problem #14: I don't understand why you need to trend the pooling charge, and I don't understand the trend used in the problem.

You are given a Jan 1 2020 pooling charge for a group of $35, with a group effective date of March 1 2020. To trend the pooling charge, they take 35 x (1+trend)^2. Why squared? I could understand if they trended it to March, or to the midpoint of the contract year, but trending it forward two years? Doesn't make sense to me.
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