Top 5 Facts Physicians Need to Know about MACRA

Implementation of the MACRA program means that physicians can no longer rely on the Sustainable Growth Rate (SGR) system to get paid for Medicare patients. Coming to terms with MACRA however, has been tedious as it has meant adhering to new rules and performance data gathering. In such an environment, physicians are getting bogged down by administrative tasks, with many spending only about 25% of their time on patient care.

With this in mind, lets delve into MACRA facts and ways to meet the requirements of the new system.

Who Falls Under the Program?

Beginning with this year the Medicare Access and CHIP Reauthorization Act (MACRA), which was signed into existence in 2015, will affect any physician or clinician who provides care for 100 Medicare patients or submits bill for more than $30,000 a year.

Implementation of MACRA

Payment adjustments to physicians will be determined under the new payment regime from January 1, 2019. Meanwhile as per the CMS proposal, performance data needs to be gathered from the first of January 2017. This period of data gathering is however flexible and so physicians who have not started the process can kick it off any time until October 2nd 2017.

Quality Payment Program

Coming under the new act is a Quality Payment Program (QPP) which includes two tracks MIPS and APM.

Merit-Based Incentive Payment System (MIPS)

Under this track, 60% score is based on quality, 25% is reserved for the advancing care information category, while the clinical care improvement practices category constitutes a score of 15%.

APM Payment Track

To qualify for the Advanced Alternative Payment Model (APM) there are several criteria. One of them is that a participant must use a certified EHR technology and have reportable quality measures equivalent to those under MIPS. Along with this, participants need to adapt to the Medical Home Model or accept elevated levels of risk. Importantly, providers who participate in this payment track and are successful, do not have to attest MIPS program if they have qualified for bonus payments.

Failure to Send Data Leads to Penalties

Physicians who fail to implement the changes during the period stipulated for providing data, will face penalty in the form of 4% reduction in payment adjustments starting from 2019. After this period, penalties will raise to 5% in 2020, 7% in 2021 and 9% in 2022.

Benefits Provided to Small Practices

Participating in MACRA data collection is being made easier for the next five years, especially for small practices as they can take advantage of $20 million of outreach and technical support provided by CMS in the period.

Options available for participating in MACRA are many, and physicians can choose to submit either partial or full data under the pathway of their choice. With payments however dependent on the quantity of data submitted and its quality, physicians stand to gain by being fully compliant with one of the tracks and at least submitting a year’s data. But for physicians and other healthcare practices that are already grappling with multiple issues starting from severe reimbursement crunch to enhanced administrative burdens, staying on top of these changes and ensuring compliance is not easy. And this is where we come in. Leveraging our immense experience in dealing with such transitions and a global team of highly experienced medical billers and coders, we can essentially be the healthcare back-office support provider that will carry the load during this difficult phase and help you deliver top notch healthcare services 24x7.

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