Quick Facts – The Medicare Access and CHIP Reauthorization Act (MACRA)

The Medicare Access and CHIP Reauthorization Act (MACRA) is a final rule issued by the Centers for Medicare & Medicaid Services (CMS). The MCARA final rule has replaced the sustainable growth formula and consolidates many existing programs into one. Let’s wrap up a few quick facts about the Medicare Access and CHIP Reauthorization Act (MACRA). The outcomes focused through the MACRA final rule are to incentivize physicians who focus on improving the quality of care, eliminate duplicate reporting, report evidence-based measures and ultimately providing patients, access to quality of care through a patient-centered approach.

The MACRA final rule combined the three existing quality reporting programs into one.

  •  Physician Quality Reporting System (PQRS)
  • Value-based Payment Modifier (VBPM)
  • Meaningful Use (MU)

Prior to MACRA physicians were paid through a Fee-for-service payment model and in most of the cases, the focus was on the volume of the services provided not value. MACRA introduced a new payment model and introduced two new tracks: Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM). The Merit-Based Incentive Payment System (MIPS) is a program that determines Medicare payment adjustments. It is composed of four categories contributing to an annual MIPS final score of up to 100 points. The performance categories are Quality which weighs 60%, Cost 0%, Improvement Activities 15% and Advancing Care Information 25%. Physicians, physician assistants, nurse practitioners, and anesthetists are eligible to participate in the MIPS track of the Quality Payment Program if you bill more than $30,000 to Medicare, and provide care to more than 100 Medicare patients per year. Clinicians who meet the criteria can participate in the program by sending their performance data by March 31, 2018, and can get eligible for the first payment adjustment that will go into effect on January 1, 2019. Clinicians can opt to not participate in the program, or submit a minimum amount of data, submit partial performance data or can submit a full year data to get adjustments for the first performance year. Depending on the track of the Quality Payment Program you choose and the data you submit by March 31, 2018, your 2019 Medicare payments will be adjusted up, down, or not at all. Under Merit-Based Incentive Payment System (MIPS), non-participating physicians have to pay a negative penalty of 4% in 2019 which will increase subsequently each year to 5% in 2020, 7% in 2021, and 9% in 2022. The Advanced Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. To qualify for The Advanced Alternative Payment Model (APM), physicians must meet three main requirements.

  1. Use certified electronic health record technology (CEHRT)
  2. Provide payment for covered professional services based on quality measures
  3. APM entities must either bear more than “nominal financial risk” for monetary losses or the APM is a Medical Home Model expanded by the CMS Innovation Center.

Sybrid MD is helping physicians and healthcare practitioners to qualify for the quality based incentives. Our team of medical billing experts can quickly analyze the current situation and design a plan of action to help physicians meet the required standards. We keep our clients continuously updated on the latest changes in the healthcare regulations so they don’t have to worry about modifications in the healthcare programs. Our medical billing experts work round-the-clock to ensure smooth operations and respond quickly whenever help is required. To get eligible and participate in the Merit-Based Incentive Payment System (MIPS) just give us a call or send a free request a quote form. MACRA, Medicare Access and CHIP Reauthorization Act, CMS Final Rule, MIPS, APM