The Sustainable Growth Rate (SGR) system that had been used for payment toward physician services in Medicare has been repealed by The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Although considered conceptually sound, a large portion of final legislative language is supposed to be vague and complex. Its success or failure depends on the decisions related to implementation of the law.
The Centers for Medicare and Medicaid Services (CMS) has released a 962-page proposed rule related to the implementation of MACRA’s key provisions. Although some adjustments have been made based on input from stakeholders, there is much work yet to be done. Major areas of concern need to be addressed in the final rule. Care has to be taken to ensure that necessary infrastructure is in place in support of the legislation.
Payment Reform under the new Act
Two different tracks of physician payment in Medicare have been established by MACRA. The first one is the Merit-Based Incentive Payment System (MIPS) and the other, Alternative Payment Models (APMs). Quality Payment Program (QPP) happens to be an amalgamation of these two. However, option to choosing one of these may not be offered to a majority of physicians in the immediate future.
Having been ridden with substantial reporting burden, MIPS may not be attractive over the next decade. This will be more so in the case of small practices that are likely to experience substantial cuts on reimbursement.
Burdens if MIPS
Drop in Reimbursement: Those who opt for MIPS will be average in performance scores, will find their inflation-corrected Medicare Reimbursements declining roughly by 18% over the next decade. Small practices operating with narrow financial margins may find their fees being reduced by 20%.
Lack of Equity: Apart from budget neutrality conformation, not much about payment adjustments is equitable in MIPS.
More administrative burden: MIPS being a complex Pay-for-performance program has substantial administrative burden. There is not much evidence to prove that significant improvements in quality of care can be achieved by pay-for-performance programs
Providers who wish to avoid the burdens of MIPS can do so by participating in advanced APM. Clinicians who have enough share of revenue from one or more APMs are eligible for 5% incentive payment from 2019 through 2024.
The objectives of MACRA – repealing the SGR, stabilizing physician payments, and fostering meaningful payment reform are agreeable. However, the situation created by the final legislative language makes MIPS becoming increasingly untenable for a huge number of providers. They may also be left with nowhere else to go by the scarcity of available APMs.
Financial pressures have been increasing on small and medium sized medical practices – several factors such as changing reimbursement paradigms, increased legal regulation needs, and even the present trend of high-deductible health policies – these pass the responsibility of payment on to the patient toward a portion of care received by them
How to Improve Bottom line of Practices by Reducing Expenses
While it is hard to increase revenue in practices, diligently handling the expense side helps in accomplishing better bottom line. Although the primary focus of health care facilities must be managing patient care as best as possible, business side also needs attention – running a practice involves meeting staffing challenges as well. Here’s where outsourcing certain processes makes sense by helping cut costs while improving business performance of the practice.
No Need to Recruit More Full Time Employees (FTEs) with Increased Billing Needs
Despite the fact that their revenue lines remain static or sometimes even decreased, more than half the medical practices surveyed in a recent study disclosed they have increased their FTEs for handling medical billing and collection. This may not prove practical on a long-term basis. It is good business sense to outsource medical billing process – it lets practices to contract only for the resources that they require at prices based on performance. This way, your practice need not absorb ancillary costs such as employees’ benefits, taxes, and workspace.
Access to most modern RCM Technology
Numinatrans has been providing Medical Billing Service to global health care facilities since over a decade. We have a team of medical billing professionals and certified specialty coders. With experience and skill, they assure complete compliance with payer and government regulations.
Contracting with Numinatrans gives medical practices access to best in class technology and leading edge that helps eliminating several medical billing issues which hinder timely reimbursement. Real time in depth reports help you understand the financial standing of your practice and its performance. All this, and software and equipment maintenance and updates at no additional cost, for managing the medical billing component effectively.
It has been proven that most medical practices that outsource their billing tasks have experienced better reimbursement, fewer compliance and regulatory issues, and quicker collections. Overall financial health of health care facilities has been seen to be robust when outsourcing their medical billing process.