2017 is considered as transition period for the newly enacted Medicare Access and CHIP Reauthorization Act (MACRA). Depending on performance, this new reform is about to either penalize or reward, or provide zero adjustment to providers’ reimbursement in the coming years.
Don’t miss MACRA Dates
Although it might outwardly appear that the financial impact of MACRA will be felt only after the beginning of 2019, it is better to understand that it may not be completely true. A maximum negative 4% adjustment penalty toward nonparticipation is possible to be slapped on those who happen to be eligible in 2017 but opt not to join an Advanced APM or submit data to MIPS. It is to be noted that for preventing penalty, it is essential to understand the eligibility needs and decide the best option for participation in 2017.
Goals of MACRA
The strategic goals for this new reform are listed below:
Improving practitioner experience by using easy to use tools
Enhancing engagement and outcomes using patient-centered MIPS and Advanced APM regulations
Promoting understanding about the program and maximizing participation
Increasing adoption and availability of Advanced APMs
Ensuring functional excellence in ongoing development and program implementation
Improving data sharing
According to the Centers for Medicare and Medicaid Services (CMS), nearly 500,000 practitioners are supposed to be eligible for participation in MIPS during the program’s first year. Performance metrics for the participants shall be submitted during March 2018. Negative or positive payment adjustments will be made on January 1, 2019.
MACRA – Mode of operation
Following two pathways are provided in this Quality Payment Program for rewarding delivery of high-quality patient care:
1. The Merit-Based Incentive Payment System (MIPS)
2. Advanced Alternative Payment Models (Advanced APMs)
MIPS streamlines three of the previous pay-for-performance programs while adding another component for promoting the ongoing innovation and enhancement to clinical processes. These categories are listed below:
Clinical Practice Improvement Activities
Advancing Care Information
MIPS provides flexibility to clinicians for reporting measures and activities which demonstrate practice performance accurately.
Advanced APM Track
Clinicians will be able to earn favorable financial rewards under this track, by taking increased risk associated with patient outcomes. Practitioners who take part in Advanced APM can earn incentive payment bonus by following patient care improvement and taking additional risk. Advanced APM participation during 2017 enables 5% incentive payment bonus in 2019.
Choose your Track
Those who opt for MIPS may select any of the three tracks, namely, a ‘test run’, ‘participating category’, and ‘all in’. MIPS-eligible practitioners who prove to perform exceptionally will receive positive adjustment.
This may be the perfect option for those clinicians having certain portion of payments of patients channeled through an Advanced APM. Eligible practitioners will get 5% incentive payment annually from 2019 to 2024.
It is expected that more than 90% of MIPS-eligible practitioners will be receiving neutral or positive MIPS payment adjustment in the transition year. This includes 80% of clinicians in solo and small practices.
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