MACRA is Coming in 2019
MACRA will be re-introduced in 2019, and will be a significant change in healthcare reform as a new model for Medicare reimbursement. The current model reimburses the provider based on volume. The new model will now require the provider to provide information on the quality of service being given, how valuable it is to the patient, and accountability that provider has to the treatment being performed. In order to measure these parts of service together, MACRA has a three part system put in place:
- PQRS, Physician Quality Reporting System
- VBM, Value Based System
- EHR, Electronic Health Record
The Physicians Quality Reporting System (PQRS) aims at having individual and group practices that bill for Medicare under Part B, to report the quality of care they are giving their patients. Participation in reporting the data can take place in two ways:
The provider can participate in an Advanced Alternative Payment Model (APM)
- An advanced payment model will give the provider a bonus incentive for certain diagnosis, episode of care or specific demographic type based on whether they are providing quality, cost effective care. These are based on pre-formatted choice models with higher risk categories.
- You can register for these model programs at The CMS Innovation Center.
Who is Included in the Quality Payment Program?
You can be considered for the program if:
- You are already registered for an APM program
- If your practices allowed charges for Part B Medicare exceed $30,000 in one year
- If your practice sees over 100 Medicare patients this year
- Both allowed charges and number of Medicare patients must be met
The provider can participate in Merit Based Incentive Program (MIPS)
- The Merit Based Incentive Program allows the provider to use measurable tests and methods of their own choice but need to be relatable back to an APM whenever possible.
Who is Included in the Merit Based Program?
You can be considered for the program if:
- You are already registered for an APM program
- If your practices allowed charges for Part B Medicare exceed $30,000 in one year
- If your practice sees over 100 Medicare patients this year: Both allowed charges and number of Medicare patients must be met.
- You are one of the following types of medical providers:
- Nurse Practitioner
- Clinical Nurse
- Registered Nurse Anesthetist
- Physician
- Physicians Assistant
Exceptions
- If this is your first year participating in the Medicare program you are not able to participate in MIPS.
How does Participation in the Program Affect your Practice?
If your practice meets the guidelines for participation it can be affected in a few different ways beginning in 2018.
- If you choose not to participate at all:
- Your practice will see a 4% decrease in reimbursement rates
- If you are in testing phase:
- You may be able to avoid the 4% penalty with enough measurable data submitted but you will not receive any incentives
- Half Participation:
- If you are partially participating in the program then you may be able to earn a small payment adjustment on claims.
- Full Participation:
- If your practice has been submitting measurable data for a year then you are on the right track to receiving a payment adjustment on those claims for quality work reported.
