Reducing Total Cost of Care and creating new Medicare billing events for your member Clinics is your ACO’s primary mission. But the increasing administrative burdens due have created an environment of financial uncertainty and lower or no shared savings distributions for member TINs.

Our ACO Support platform reduces Total Cost of Care, improve Quality Scores, provider utilization, billing encounters, reimbursement, and shared savings distributions that meet the expectations of Member TINs.

Top-Performing ACOs Should Only Utilize the Services of Top-Performing Professionals.

• Our service provider partner is the most qualified and the “best-in-class” at helping ACOs address and bridge vulnerabilities.
• Their skillset, strategies, tools, and support provide the structure that increase billing encounters, reimbursement, shared savings, and patient satisfaction.

Their team is deeply experienced in healthcare and largescale program implementation and operations. And their comprehensive understanding of regulatory requirements and advanced proprietary software technology, which their leadership team has a deep investment in - make them the ideal service partner.

And continuous updates in response to industry changes make their technology platform crucial for meeting quality metrics and achieving better patient outcomes.

How much money has your ACO invested in the systems and processes (and people) that help to optimize results? What is the annual ROI to your member TINs? And what are you doing to create an increase in ROI?

Many ACO executives boast about their cost of care, Quality scores, robust risk adjustment, cost savings, abstract coding teams, QA audit teams, care coordination, and provider education. But now they need new and significant value to show their Board and Member TINs.

Our ACO Support platform is the solution. It provides the support ACOs need and all services are tailored to the ACO and their member TIN's specific needs, which can change from one year to the next.

We offer a comprehensive suite of services:

• Medicare CCM for ACO
• MACRA for ACO (QPP & MIPS)

See below and our services webpages for the important details on each.

The Bottom Line

Our ACO Support platform is the empowering solution that ensures your ACO meet its mission goals with unparalleled technology, guidance, and support.

We will help you and member clinics meet all requirements, improve quality scores, patient outcomes, and reimbursement, reduce Total Cost of Care, and unlock Medicare CCM revenue streams.

Why M-CCM is Mission Critical for ACOs

• CMS estimates that M-CCM reduces Medicare costs by $74 pmpm.
• M-CCM and ACO overlap in mission-critical areas.
• Chronic condition-based quality.

Where clinical Quality Measures reference chronic conditions, the presence of M-CCM goes far in sustaining visibility into chronic patients.  And visibility is a first step in managing quality.

Chronic Condition-Based Cost

Cost measures are completely based on Medicare patients.  This makes M-CCM particularly powerful in the ability to influence utilization of expensive services, by pre-empting the need with ongoing clinical care.

Currently Utilizing EHR for M-CCM Program Management

If your ACO or member TINs are currently offering eligible patients M-CCM and utilize EHR for program management, you may require a software platform that integrates and provides all necessary billing data. Our Software-Only option could be the perfect solution for you because its advanced software tools will scale your M-CCM efforts upwards.

If you only have one care manager and a small number of patients, your staff can manage the process manually. But as patient volume grows, those manual processes create errors and bottlenecks that will constrain efficiency and the ability to reach patients who will benefit from M-CCM.

ACO M-CCM Snapshot

We will show you what your ACO and member TINs M-CCM opportunity looks like. If you have not received it from us yet, we will email you a pdf of a CMS M-CCM Data Snapshot for your ACO and a few of your member clinics, which will show you how much more revenue can be captured by billing CPT 99490 and its related codes.

The summary will break down the data for you in very simple language.

Click Here or see the link below to request your organization’s snapshot.

Reserve a Call with Us

In a 30-to-60-minute Zoom call, we will talk about your M-CCM Snapshot and our team, qualifications, and the Feasibility Analysis that will help your ACO meet its mission goals and provide you with something you will be proud to show all your decision makers, board, and member clinics. In the least case, you can learn about a CMS program you have yet to benefit from.

Click Here to go to our Calendly page to reserve your Zoom call with us. Complete the required fields and when asked “purpose of call,” click: ACO Support – M-CCM.

If you are already offering M-CCM and only interested in our software platform, click: ACO Support-M-CCM – Software-Only.

Supporting Materials

Take a few moments to download our brochure, platform details, and CMS data supporting materials below.

• Live Well A.P.S. Medicare CCM Brochure (pdf).
• Live Well A.P.S. ACO Medicare CCM Platform Details (pdf).
• CMS MLN CCM Booklet (pdf).
• Medicare Chronic Care Management for Seniors article (link).
• CMS Outreach and Education on CCM report (pdf).
• Mathematica 2017 report on CCM (pdf). (This is an important study, but a bit long.  See page 64 for the Bottom Line)

MACRA requirements make up thousands of pages of regulations in the Federal Registry and are a very complicated beast and no small task to manage or optimize.

Though most ACOs did a good job meeting Quality Measures in the past, many are missing the opportunity to help Member TINs qualify for the maximum payment adjustment of up to 9%.

MACRA is Worth Money$$

The high cost of doing business has been met with inadequate increases in reimbursement by CMS. But MACRA can actually help.

Make sure your Member TINs don’t leave any money on the table. Help them qualify for up to the maximum payment adjustment in the next PAY.

Understanding the financial implications of the QPP & MACRA helps in making the decision on whether to invest in MACRA Optimization / Registry Services or stay the course with your ACOs current effort - very easy.

The only thing worse than failing to maximize your member TINs payment adjustment is not taking the simple steps to help them qualify for it.  And that’s exactly what many ACO decision makers are doing.

MACRA Facts

The QPP & MACRA went into full effect on January 1^st, 2022. But up until 2024, it was just a compliance checkbox issue and a nuisance. But now eligible ACO Member TINs, physicians, and clinicians receive a positive or negative payment adjustment of up to 9% more, or up to 9% less on their Medicare Part B claims submissions, based on your ACOs (or their own) Corresponding Performance Year Final MIPS Score (note* Critical Access Facilities & Federally Qualified Healthcare Clinics are exempt).

MACRA requirements make up thousands of pages of regulations in the Federal Registry and are a very complicated beast and no small task to manage or optimize.

Though most ACOs did a good job meeting Quality Measures in the past, many are missing the opportunity to help Member TINs qualify for the maximum payment adjustment of up to 9%.

The MACRA Optimization Cycle

Optimization consists of a 9-step process that can only be achieved with an Active or On-Going Program that follows a regiment of extract, report, analyze, plan, and act for each quarter or month. And only by taking each step can your ACO earn an exceptional Category Weights and a Final MIPS Score that will qualify your member TINs for the maximum payment adjustment in the next PAY.

Technology That Provides More Than EHR

Who Needs It? (Epic, Cerner, Allscripts, eClinical Works) - Almost All EHR Users

EHR’s can't submit MACRA data directly to CMS.  In fact, it can be hard to even analyze MACRA data in meaningful ways.  That's why the platform subscribers get better reimbursements, with less manpower.

Physicians Buy EHR for Patient Care - Not for Fast-Moving Regulatory Compliance

Managing MACRA from a physician point of view should be a by-product.  We find that even the best EHRs only keep up with MACRA at the superficial level of creating numerator / denominator values, and honestly - those rules don't change much.

CMS Publishes Hundreds of Pages of New MACRA Rules Each Year 

Our platform relies on EHR to do the numerator and denominator work but does all the rest relating to those hundreds of pages.

EHR Plugin

Our platform is a cloud-based tool that connects to EHR with no local software needed.  And our enhanced reporting and sophisticated concierge team will take it to the next level - beyond simple numerator / denominator content.

Whether EHR is sophisticated enough to create QRDA3 output, a simple spreadsheet, or just a PDF - connecting to the platform simplifies connecting to CMS.

Automated Data submission

With our platform there is no need to manually submit or upload data via EIDM.  It provides an automated streaming API directly to CMS, with automated response and tracking at the level of TIN, Provider, MIPS Category and Measure.

MACRA Financial Projections

Our platform automatically queries CMS for Medicare billing and payment history for each provider.  Then it applies statutory minimum / maximum expectations based on each year's MACRA rules, adjusted for estimated CMS Scaling Factors.  It then sets budgets that tie operational performance with financial performance.  Finally, as it accumulates PI, CQM, Cost, and CPIA data throughout the year, it displays actual financial results against these budgets.

Provider Dashboards and Scorecards

Our platform's excellent dashboard integrates financial performance with MACRA operational performance in uniquely powerful models.   It flags individuals, TINs, and customizable groupings against operational targets throughout the year. And it provides potent provider communication tools that clearly share the impact of performance.

Analysis of Alternatives

As our platform tracks actual performance data throughout the year, you will have instant visibility into which submission models (Group / Individual, EHR / Registry, ACO / Advanced APM / Standalone), which earns the greatest MACRA reimbursement.

Physician Compare / Review and Correction Cycle Management

Submission is not the end of your MACA Season. CMS ultimately will echo back their understanding of submissions, and gives the chance to agree, or to submit data for further review.  Our platform gives provider groups the tools to manage the overall process.

Complex TIN and Provider Organization Management

No one tracks complex organizations like our platform.  Its tools incorporate not only TIN dashboarding but also identify the key workflow steps that keep track of progress across complex TIN structures.

Software + Concierge

Because our platform is independent of EHR and Registry offerings, it is in a unique position to identify, configure, and submit your very best MACRA options.  It often blends from multiple offerings, which really fine-tunes your result.

Tools and Consulting Combined

Not even the best tools stand alone.  And not even the best consultants can organize and optimize complex data.  We believe your needs include both consulting and software thoroughly integrated.

Your Concierge is always available for help with any MACRA tasks.  Our platform’s software integrates with any EHR and any Registry to give you the best of both worlds.

MACRA is much more than a year-end submission exercise or a periodic measure calculation.

You can’t improve performance by looking at your metrics after the year is over.  And simply making numbers available a couple times a year only improves things a little.

At times, your ACOs Category Weights and Final MIPS Score may not be complete and/or accurate. And while some solutions can be applied retroactively, many require that coders or physicians change the way they describe things or even change physician behavior.

Many so-called MIPS or MACRA experts’ (vendors) give lip service to CMS quarterly or monthly requirement of integration and feedback. They get by with a dashboard that clients can look at any time. Such a passive approach is NOT dependable. The fact is – a dashboard is the least dependable of all.

What Else is Required

For your Member TINs with fewer than 100 physicians & clinicians, it should be enough to run reports from your EHR quarterly, post them to a standalone MACRA database for performance analysis, and discuss shortfalls against targets.  For complex multi-TIN organizations, MACRA Optimization steps need to be done monthly.

Sophisticated program analytics is required because raw MACRA data doesn’t mean a lot to ACO and TIN management, physicians, or clinicians.  By adding the financial impact, this creates a clear frame of reference. And once CMS publishes their Physician Compare content, the MACRA team should study the impact of public scores on the flow of new patients.

Many of your mid-to-large sized Member TINs may need at least one person with the expertise, time, and resources (including access to external expertise) to maintain or achieve the highest performance status.

If your ACO is already working with a MACRA or MIPS vendor or Registry, you still need an independent 3rd party review of their work to ensure they’re following up on all requirements. Because you can’t afford to find out if they’re not after the fact.

We will also help your ACO identify areas that need improvement for getting a patient scheduled for Medicare Chronic Care Management (M-CCM) conditions.

Payment Adjustment Remittance Verification

In PAY 2025, CMS reports that more than 21% of all MIPS eligible TINs, physicians, and clinicians will be penalized with a negative payment adjustment.

It is estimated that more than $4 billion will be redistributed to 2023 top MIPS performers in 2025.

Your Member TINs can find their payment adjustment in their QPP Detailed Final Report. But they need to verify the payment adjustment on each claim they submit because it will not be easy to identify and will require a bit of calculation to show if it is correct. It will show as a dollar amount on their remittance advices, but to determine if it is accurate they will need to convert it to a percentage and compare it to the expected percent for the submitting physician, which will not appear on their remittance advices. Our Payment Adjustment Remittance Verification pulls the expected percent from the CMS / QPP database and compares that value to the value calculated on your Member TINs Remittance Advices.

Your management team needs to contemplate the value of the payment adjustment in the Medicare Fee Schedule under the QPP & MACRA to those same TINs knowing that a single point (increase or decrease) in MIPS score will probably be worth up to $250k or more.

Some of our MACRA solutions will be oriented towards your ACO (i.e., calculation of eCQMs under optional / mandatory regulations, and real-time calculations of ACO-level MACRA (MIPS) scores throughout the Corresponding Performance year (CPY), and others towards your Member TINs (i.e., enabling a hierarchy of CQM, PI, IA, & Cost evaluation and submission and Patient Engagement options that can enhance the TINs Payment Adjustment Year (PAY) revenue and reimbursement beyond ACO-level results).

We will help your Member TINs earn that return and probably for considerably less than half the cost of a single new hire.

eCQM

As CMS incentivizes ACOs to integrate eCQM into their reporting repertoire, your Member TINs will look to your ACO for guidance. We provide the needed knowledge, tools, and people to support all required data collection, communication, and analytics to help. And quite probably do it for less than the cost of one employee.

Our formal process for optimizing MIPS (Category Weights Scores) proves that early corrections have big impact, and that year-end (submission-time) analysis has little or no impact on improvement.

Advanced APMs

Advanced APMs are exempt from MIPS. However, most if not all physicians will likely fall into “Partial QP” status due to the QP threshold increase from 50% to 70%.

The impact is that Partial QPs are optional MIPS submitters. But with your normal high performance, submissions should earn your member physicians more than their historical QP reimbursement of 5%.  (Note: by electing to not submit they receive zero).

Here is the best option going forward - First, as Partial QP’s, submission should be made by all TINs individually, and the ACO-level CQM submission does not apply.  In this approach, we fulfill the role of ACO support by interacting with each TIN throughout the year to optimize their own Category Weights Scores. For all but one TIN, this will involve generating CQM data from their Certified EHR. This approach will avoid any chance of penalties and maximize earning & efficiency for your Member TINs.

ACO MACRA Snapshot

We will show you what your ACO and member TINs MACRA opportunity looks like. We will email you a pdf of a CMS data snapshot on your ACO and a few of your member clinics, which will show you how much more revenue can be captured with MACRA optimization.

The summary will break down the data for you in very simple language.

ACO MIPS Data Analysis

This analysis is an invaluable tool to present to your board and member TINs. It will include an MACRA Strategy Report and data spreadsheet that calculates your MIPS opportunity based on the current PY.

Reserve a Call with Us

In a 30-60-minute Zoom call, we will talk about your snapshot, our qualifications, and our Strategy Report that will show you how much more reimbursement can be captured, and how we can help your ACO meet its mission goals and provide you with something you will be proud to show your board and member clinics.

Click Here or see the link below to go to our Calendly page to reserve your Zoom call with us. Complete the required fields and when asked “purpose of call,” click: ACO Support – MACRA.

Supporting Materials

 Take a few moments to download our brochure and supporting materials below.

• Live Well A.P.S. MACRA Brochure (pdf).
• 2025 CMS Final Rule (pdf).
• Qualified Registry - A Pathway to Success within MACRA (pdf).
• NQS Report (pdf).