What You Need to Know About MACRA

What You Need to Know About MACRA

The Medicare Access and CHIP Reauthorization Act (MACRA) is a bipartisan bill approved by congress in April of 2015. As The Centers for Medicare and Medicaid Services (CMS) puts it, MACRA is designed to “reward better care, not just more care.” This is in line with Medicare’s and Medicaid’s move away from the fee for service payment system to a value based payment model and their goals for improved care, wiser spending and healthier people. The plan is to eventually have 85% of all Medicare reimbursements be tied to quality and value of care.

MACRA focuses on three primary areas: physician incentives, care delivery and information sharing. The real victory of MACRA, as far as physicians are concerned, is its repeal of the Sustainable Growth Rate (SGR).

Two Paths to Participation

Physicians can choose between two different paths in the Quality Payment Program: Alternative Payment Models (APMs) and Merit-Based Incentive Payment System (MIPS). CMS projects that most Medicare providers will take part in MIPS but eventually move on to an APM.

MIPS draws numbers from measurement systems already in place like the Physician Quality Reporting System and the Medicare Electronic Health Record Incentive Program (‘Meaningful Use’), to determine physician payment adjustments. It is only available to private practices, not hospitals or clinics. With MIPS doctors are given a composite score based on their performance in four categories. The score, which considers resource use, quality, clinical practice improvement, and Meaningful Use of EHR, will be used to raise or lower physician payments by a designated percentage. In 2019, when the adjustments begin, the rate will be plus or minus 4%. By 2021 it will increase to plus or minus 9%.

Alternative Payment Models (APM’s) are the second MACRA payment track and are meant to incentivize value and quality care. Some examples include Patient Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO). Other models are in trials around the country. Not all current APM’s will be eligible for these payment tracks, but those will be able to take part in MIPS. Organizations that are deemed eligible will be exempt from MIPS.

While performance measurements are due to begin in January 2017, MACRA payment adjustments will not begin until 2019. More information, and toolkits, are available on the CMS, American College of Physicians, American Academy of Family Physicians and American Medical Association websites. You can also turn to the consultants at ProMD Medical Billing for help preparing for the new payment models. Call us today to learn how we can help.

ProMD Medical Billing is happy to help with your billing assessment needs so you can maximize profits and increase patient satisfaction. To learn more about how ProMD can make your practice run like a well-oiled machine, call 866-960-9558 or fill out our online form to request a billing assessment.