The Medicare SGR was axed in 2015 much to the pleasure of physicians and healthcare administrators around the country.
We are now getting a picture of how the replacement payment plan set forth in The Medicare Access and CHIP Reauthorization Act (MACRA) law will work.
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Here are 12 facts to get you up to speed:
- MACRA reimbursement plans apply only to practice physicians and Medicare
- Reimbursement under MACRA starts in 2019 using data collected by CMS in 2017
- From 2016 to 2019, reimbursements are scheduled to increase under the MPFS by .05% per year
- There are two ways to participate:
Merit-Based Incentive Payment System (MIPS) combines Value-based Payment Modifier (VM), Physician Quality Report System (PQRS) and Meaningful Use (MU)Advanced Alternative Payment Model (APM)
- Program year 1 will see most physicians participating in MIPS
- Providers can change between the MIPS and APM programs annually as it best applies to their practice
- MIPS is budget-neutral, higher reimbursements are balanced out reduced reimbursements to low-scoring practices
- Physicians with high performance scores can see 4% rate increases in 2019, progressing to as much as 9% in 2022
- MIPS will be scored in 4 categories:
QualityCost-of-care/Resource Use
Clinical Practice Improvement Activities
Advanced Care Information (formerly Meaningful Use)
- APM physicians from 2019 through 2024, will receive a lump sum payment of 5% of their prior year Medicare Part B payment
- APMs are payment models such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs)
- CMS will update the list of qualified APMs annually