The Medicare Access and CHIP Reauthorization Act— MACRA—presents a new approach to payment for most physicians and clinicians who participate in the Medicare Part B program. It’s an approach that is heavily focused on value, with risk-based payment adjustments for quality, cost and more.
Clinicians who are part of an Advanced Alternative Payment Model (APM) already participate in the Medicare Quality Payment Program. Other eligible clinicians (ECs) that are required to participate or risk receiving a negative payment adjustment in 2019 include:
Clinicians exempt from year one: first-year Medicare Part B participants and those who do not meet the minimum thresholds for participation (those who bill less than $30,000 in Medicare Part B allowed charges or who provide care for fewer than 100 Medicare Part B patients).
There are two tracks for participation under MACRA.
Merit-Based Incentive Payment System (MIPS): In 2017, CMS estimates that 90 percent MACRA-eligible clinicians will report under MIPS.1 These include physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists.
There are three options for participation in MIPS this year:
Advanced Alternative Payment Model (APM): If you receive 25% of Medicare covered professional services payments through an APM or see 20% of your patients through an APM in 2017, you could qualify for this track.
The first performance year for MACRA began Jan. 1, with the financial impact being felt in 2019. Keep these key dates in mind:
MACRA is a competitive scoring program for clinicians, with clinicians receiving a composite score for their performance across categories.
For MIPS, scoring categories comprise of:
CMS will set a performance threshold each year that equals the mean or median of all MIPS scores from the prior period.
In 2017, 60% of the MIPS score will be based on the quality data submitted.
Cost will not be evaluated until 2018.
Yes—unless you meet the minimum qualifications for avoiding a negative payment adjustment (for example, reporting quality data around one measure for 90 days this year). Under MIPS, payment adjustments will range from negative 4% to 4% in 2019 based on participation and performance this year. CMS estimates approximately 90 percent of MIPS-eligible clinicians will receive a positive or neutral payment adjustment.2
Based on their scores, some MIPS participants could qualify for an exceptional performance bonus. Qualifying APM participants could receive a 5% Medicare Part B incentive.
MIPS scores will be publicly reported on the Physician Compare website and available to third-party vendors—so putting your best foot forward in 2017 is key.
Visit the Centers for Medicare & Medicaid Services’ Quality Payment Program site or schedule a consultation with our MACRA experts to develop a plan for meeting reporting requirements. Email firstname.lastname@example.org or call 800.444.0882.