The much-anticipated Medicare Access and CHIP Reauthorization Act (MACRA) final rule this month has been finally released by CMS (Centers of Medicare and Medicaid Services). Extensive changes have been made by his rule to traditional Medicare Part B reimbursement. MACRA moves Medicare away from a significantly volume based fee-for-service system to a value-based system as part of an overarching technique to transform how health care is delivered in USA by rewarding quality improvement, concentrating on patient health outcomes, and decreasing unimportant costs.
The administrative burden has been eased by the final rule for provider transition to MACRA, broadens opportunities for involvement in advanced alternative models (APMs) and sets aside funding to offer technical help to Merit-Based Incentive Payment System (MIPS) participating clinicians in areas with a shortage of health professionals.
Answers to 10 most frequently asked queries are mentioned below:
1. What is the Quality Payment Program?
The Quality Payment Program (QPP) of MACRA replaces the sustainable growth rate and sustains the shift of agency toward value-based care reimbursement reform. Medicare Part B participating providers must opt between 2 tracks: APMs or MIPS.
If providers opt to participate in an Advanced APM via Medicare Part B, they will gain an incentive payment. If, rather, a provider opts to participate in traditional Medicare Part B, he or she’ll participate in MIPS, and will gain a performance-based payment adjustment.
Providers might participate as an individual or a group.
2. Who is affected?
Physician assistants, Physicians, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists who participate in Medicare Part B, bill Medicare more than
$30,000 per year and give care for more than 100 Medicare sufferers a year. Note the proposed rule had set the threshold at $10,000 per year.
3. When does the Quality Payment Program begin?
On the day of January 1, 2017, the first performance year starts and ends on December 31, 2017.
A clinician can give care during the year through that model if already participating in an Advanced APM and will be eligible for a 5 percent incentive payment. Clinicians must participate in MIPS if not participating in an Advanced APM, or will get a negative payment adjustment.
In the 1st year of the program, 2017, clinicians can choose the pace of participation in MIPS. Between the 1st of the year and October 2nd, clinicians can start gathering performance data anytime. Data must be submitted to CMS by the day of March 31, 2018 in order to gain a positive payment adjustment.
Medicare will give feedback to providers after data submission. If a positive MIPS payment adjustment or Advanced APM incentive payment is earned, clinicians will get the money starting on the day of January 1, 2019.
4. How the Medicare payments change?
Relying on the information submitted by the day of March 31, 2018, 2019 Medicare payments will be adjusted up, down, or not at all.
5. How does the final rule impact APMs?
Advanced APMs permit practices to get incentive payments for taking on financial risk related to patient results. 2017 qualifying Advanced APMs will be declared by CMS on January 1, 2017. As of now, the agency has declared 2017 qualifying advanced APMs involve:
Comprehensive Primary Care Plus (CPC+);
Comprehensive ESRD Care (two sided risk model);
Shared Savings Program – Track 2;
Next Generation ACO Model;
Shared Savings Program – Track 3.
6. How does the final rule impact MIPS?
Prior CMS initiatives (PQRS, Meaningful Use and Value Based Modifier) with 4 categories have been streamlined by MIPS: Quality, Improvement Activities, Advancing Care Information and Cost.
CMS won’t use the Cost category to determine payment adjustments in 2017. Rather, the agency will calculate payment adjustments solely deployed on the Quality (60 percent of weighted score), Improvement Activities (15 percent of weighted score) and Advancing Care Information (25 percent of weighted score) categories.
7. How does the final rule affect small practices?
The burden on small practices has been eased by the final rule. Several small practices are excluded from new requirements in 2017, because they see less than or equal to $30,000 in Medicare Part B charges or less than or equal to 100 Medicare sufferers each year. However, it doesn’t apply in the year of 2017, in future years, MACRA will permit solo and small practices to combine and submit MIPS reporting together as virtual groups of no more than ten clinicians.
8. How do I know if I am ready to participate in MIPS?
Determine if you’ll submit data individually or as a group. Then, consider which measures you’ll submit to CMS in each of the 3 categories: improvement activities, quality, and advancing care information. Use the QPP Website to explore and observe the MIPS data your practice can select to submit. Select quality, advancing care information and improvement activities measures which best suit your practice.
Next, think how you’ll submit data: through qualified data registry, registry, CMS web interface (for groups) or electronic health record (EHR). If you select to submit through electronic health record (EHR), determine that your EHR is certified by the Office of the National Coordinator for Health Information Technology. If so, CMS shows your EHR is ready to capture data for the MIPS advancing care information category as well as specific quality category measures.
9. How can I learn more?
CMS inaugurated the Quality Payment Program website on Friday. The Agency will sustain to host listening and learning sessions throughout the country. Furthermore, CMS will sustain to accept comments on the final rule through the day of December 17, 2016, 60 days after the final rule release date.
If you’ve extra queries about how MACRA will impact you and your practice, you should contact a qualified health care attorney or your billing provider.
10. Where can I read the final rule?
You can read the final rule here: https://www.federalregister.gov/documents/2016/11/04/2016-25240/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm.