Scratching the Surface of MACRA

I have no less than 10 articles starred in my email inbox all related to MACRA, MIPS and APMs.  I have finally decided to take a stab at getting my head around this big change for 2017 quality reporting.  Hopefully, I can provide some insight to others as well.

I decided to start at the beginning:does MACRA make you scratch your head?

What is MACRA?

MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015.  This act ended the Sustainable Growth Rate (SGR) formula.  The SGR was originally developed to rein in Medicare costs.

How does MACRA help reduce Medicare costs?

It establishes the Quality Payment Program. Quality care = healthier patients = reduced healthcare costs.

What makes up the Quality Payment Program (QPP)?

There are two programs providers can choose from:

1.       Advanced Alternative Payment Models (APMs)– through Medicare Part B you may earn an incentive payment for participating in an innovative payment model.
 

2.       The Merit-based Incentive Payment System (MIPS) – you will earn a performance-based payment adjustment.

Who is included in the QPP?

You billMedicare more than $30,000 in Part B allowed charges a year and provide care for more than 100 Medicare patients a year.

MIPS is applicable to only these types of providers:  physician, physician assistant, nurse practitioner, clinical nurse specialist, and certified registered nurse anesthetist.

What do you need to report?

For MIPS, 90 days of quality data is required. The reporting period began 1/1/2017.  You can start up until 10/2/17 in order to provide the minimum amount of data.

When do you need to report?

                  The deadline for submission is 3/31/2018.

If you report successfully under MIPS, what happens?

You may earn a positive payment adjustment in 2019. The size of your payment will depend both on how much data you submit and your performance results.

If you do not report successfully under MIPS, what happens?

                For zero data = -4% in 2019.

Do the APMS have same incentive?

If you receive 25% of Medicare payments or see 20% of your Medicare patients through an Advanced APM = +5% in 2019.

   I feel like I have started to peel away the first layers. 

Stay tuned to the Iridium Suite’s Medical Billing Blog
in the coming weeks for more in depth information.