5 Changes to Healthcare Caused by MACRA

What is MACRA?

The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law on April 16, 2015. This U.S. statute was one of the largest scale changes to the American healthcare system. The MACRA provisions change how Medicare physicians are reimbursed, increase Medicare funding, and extend the Children’s Health Insurance Program (CHIP).

This new legislation was designed with the emerging value-based care model in mind. Several related regulations change provider incentives for use of health information technology. Despite its significance, many physicians and providers are unsure of how MACRA will impact them. This helpful guide identifies five changes to healthcare brought on by MACRA, as well as what practices and medical organizations can do to prepare for its full implementation in 2019.

1. MACRA dramatically changes how CMS pays you

MACRA established the new Quality Payment Program, which impacts providers. The QPP repealed the Sustainable Growth Rateformula, which resulted in a significantly decreased Physician Fee Schedule, causing downward pressure on provider reimbursements. CMS now incentivizes value-based care over the previous volume-based model through the new Merit-Based Incentives Payment System (MIPS). It also gives bonus payments for participants in Alternative Payment Models (APM).

2. MACRA gives you more reimbursement options

Prior to MACRA, providers were at the mercy of the Sustainable Growth Rate Formula. Now Medicare Part B participants have two options within the QPP. The first is the Advanced Alternative Payment Methods (APM). The second is through the Merit-Based Incentive Payment System (MIPS). The new QPP allows participants greater flexible in regards to how they want to participate in Medicare based on practice size, specialty, location, or patient population. Under MIPS, your practice will earn a performance-based payment adjustment.

This payment program allows three options where your practice can pick its pace in terms of how much you want in your MIPS payment adjustment.

Option 1: If you submit the minimum amount of 2017 data to Medicare, you can avoid a downward payment adjustment.

Option 2: If you submit at least 90 days of 2017 data to Medicare, you may earn a neutral or positive payment adjustment. It is possible to earn the maximum adjustment under this option too. There is nothing in this MIPS program that penalizes a reporter with a lower score for 90-day reporting, as opposed to a full year of reporting.

Option 3: If you submit the full year of 2017 data, you could earn a positive payment adjustment, possible the maximum adjustment.

3. You need to submit 2017 data to CMS

Medicare reimbursements are both the carrot and the stick. If you submit your 2017 data to CMS, you will receive your reimbursements in accordance with your payment options. You need to choose one of the three payment 3 options. If your practice chooses not to submit any 2017 data to Medicare, you will receive a negative 4% payment adjustment. These are applicable to 2019 Medicare data only. CMS will determine guidelines for data in 2020 and beyond.

4. Innovation is rewarded through the APM

If you participate in Advanced APM, you may receive an incentive payment for participating in an innovative payment model. Your practice can earn a 5% incentive payment in 2019 if you either received 25% of Medicare Payments through Advanced APM in 2017 or saw 20% of your Medicare Patients through an Advanced APM in 2017.

5. You can report individually or with a group

Individual Reporting

If you report your 2017 data to CMS as an individual, your payment adjustment will be based on your performance. An individual in a single clinician who is identified by one National Provider Identifier (NPI) and a single Tax Identification Number (TIN). You have to send your data for each of the MIPS categories via an EHR or a registry. There is another option to send in data through your routine Medicare claims process.

Here are the ways to submit data:

  • Attestation
  • Administrative Claims
  • Electronic Health Record
  • Qualified Clinical Data Registry (QCDR)
  • Qualified Registry

Group Reporting

Each eligible practitioner will receive a payment adjustment based on the group’s performance. Under MIPS, a group has one TIN with at least two eligible clinicians, identified by their NPI, who assigned their billing rights to the TIN

Here are the ways to submit data as a group:

  • Attestation
  • CAHPS for MIPS Survey (available for groups with 2 or more eligible clinicians)
  • CMS Web Interface (only available to groups with 25 or more eligible clinicians)
  • Electronic Health Record
  • Qualified Clinical Data Registry (QCDR)
  • Qualified Registry

Get started today

MACRA fundamentally changes the way Medicare Part B participants are reimbursed by CMS. As this law is fully implemented, it is important for providers and practices to be prepared. You are now required by law to abide by the rules and requirements established by MACRA. If you haven’t developed a MACRA strategy, there is still time before the final rules go into effect. EHR Integration Services understands MACRA inside and out. Our team has first-hand experience advising individuals and groups on MACRA best practices, strategy, and execution. If you want to maximize your CMS incentives while remaining compliant with the law, let us work with you.