The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has replaced the Sustainable Growth Rate (SGR) formula. As a result, new guidelines for paying providers for care administered to individuals enrolled in Medicare Part B will come into effect for the following calendar year.
Providers that participate in MACRA through the Merit Based Incentive Payments System, or MIPS, reimbursement structure will be compensated based on the quality and efficacy of the care they provide. Through this system, providers will receive a composite performance score, which will be derived based on:
- PQRS standards for care quality (will account for 50% of the total score)
- VM standards for resource use (10% of total score)
- Clinical practice improvement based on the new CPIA program (15% of total score)
- Meaningful use of certified EHR technology (25% of total score)
Providers will then receive an adjustment to the base rate of their Medicare Part B reimbursements. These adjustments can be positive, negative, or neutral. With the reporting period for the new criteria beginning January 1, 2017, how can you prepare your practice for value-based care using the MACRA/MIPS reimbursement structure?
Understand How to Avoid Penalties & Choose How You Will Participate
Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services has recently outlined three ways in which physicians can participate in the first MIPS reporting period of 2017 in order to avoid a negative adjustment for payment in 2019.
- Test the Quality Payment Program
This first option is intended to gauge whether the physician’s system is working and that their practice is prepared for broader participation in the Quality Payment Program in subsequent years. As long as providers send some data, including information from after January 1, 2017, to the Quality Payment Program, they will not be given a negative payment adjustment.
- Report to the Quality Payment Program for part of the year
Eligible providers can choose to submit information to the Quality Payment Program after January 1, 2017. As long as providers report information outlined for the composite performance score, their practices could qualify for a slight increase in their adjusted payment.
- Report to the Quality Payment Program for the full year
If practices are prepared to start reporting for the 2017 calendar year, they may start submitting information to the Quality Payment Program on January 1st. If practices submit information required by the criteria outlined for the composite performance score for the entire 2017 reporting period, they may qualify for a larger positive payment adjustment.
Fulfill Criteria of Existing Incentive Programs
The Merit-Based Incentive Payments System (MIPS) reimbursement structure is a combination of the following, existing incentive programs:
- Physician Quality Reporting System (PQRS)
- Value Modifier (VM or Value-Based Payment Modifier)
- Medicare Electronic Health Record (EHR)
Currently cooperating with these programs will make the transition a lot smoother. Incorporating the use of certified EHR technology (CEHRT) with a meaningful use reporting module is an efficient way to meet requirements associated with both Meaningful Use and PQRS programs.
The finalized rules for participation and reimbursement will be published in November and the full MACRA timeline can be viewed here.
1st Providers Choice Can Ensure Your Practice Meets MACRA Requirements
1st Providers Choice EMR and practice management software can ensure you meet the necessary requirements outlined by MACRA for a positive reimbursement adjustment. For more information, contact us online or call us at 480-782-1116.