10 questions about MACRA

10 questions about MACRA everybody wants to know the answer for!

The Medicare Access and CHIP Authorization Act, (MACRA), has been met with widespread relief and a tad bit of suspicion. As always conspiracy theories and unanswered questions are in the air. Here are 10 major questions that everybody wants an answer for.

1. What exactly is MACRA? The Medicare Access and CHIP Authorization Act, (MACRA), will permanently replace the dreaded Sustainable Growth Rate formula for determining payments.

MACRA seeks to: 

Provide payments based on quality and outcomes rather than volume



To consolidate major incentive programs like PQRS, value based payment modifier, Meaningful Use and the Medicare Electronic Health Record incentive program into one single, comprehensive framework. Though the existing incentive programs will be retired, the Merit Based Payment System (MIPS) will retain the foundational ideas of the current quality reporting programs.



Health information technology will play a major role

2. How will MACRA impact payments?

There are 2 paths for payment in the MACRA legislation. 

The Merit Based Payment System (MIPS)



Alternative Payment Models (APMS)

3. Tell me more about MIPS Eligible clinicians will be evaluated based on 4 categories: Quality- based on the existing PQRS system Resource use: based on the Value based payment modifier model Advancing Care Information: which is similar to MU mandates Clinical practice improvement categories The scores for all the measures will be rolled up into a composite performance score. Once the composite performance score is arrived at it will be compared against a threshold which will be used to make payment adjustments.

MIPS payment adjustment at a glance 

Submission



Category scoring



Calculation of composite performance score



Comparison between composite performance score with composite performance score threshold



Payment adjustments

4. Am I eligible to participate in MIPS? You are eligible if you are a physician, registered nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist. Going forward, the secretary may broaden the eligible clinician group to make occupational therapists, speech language pathologists and nutritional professionals to become eligible to participate in MIPS as well.

5. Will MACRA eliminate fee for service?

MACRA preserves the fee for service model. Physicians who follow the fee for service model can participate in the MIPS program.

6. What are the data submission requirements of MIPS? MACRA intends to follow a single, unified data submission method for all the performance categories. To achieve this goal MIPS expands on the existing quality measures and simplifies the data submission process.

The submission guidelines for individuals are: Measure 1: Quality 

Claims



QCDR



Qualified registry



EHR vendors



Administrative claims (submission not required)

Measure 2: Resource use 

Administrative claims

Measure 3: Advancing care information 

Attestation



QCDR



Qualified registry



EHR vendor

Measure 4: CPIA 

Attestation



QCDR



Qualified registry



EHR vendor



Administrative claims

Data submission options for groups: Measure 1: Quality



QCDR



Qualified Registry



EHR Vendors



CMS Web Interface (groups of 25 or more)



CAHPS for MIPS Survey



Administrative Claims (No submission required)

Measure 2: Resource use 

Administrative claims (No submission required)

Measure 3: Advancing care information 

Attestation QCDR



Qualified Registry



EHR Vendor



CMS Web Interface (groups of 25 or more)

Measure 4: CPIA 

Attestation



QCDR



Qualified Registry



EHR Vendor



CMS Web Interface (groups of 25 or more)

7. What should I do prepare myself for MIPS? 

If you are already reporting quality measures under the existing incentive programs identify and focus on your high performing quality measures



Evaluate and educate your staff on QRUR (quality resource and use report) by CMS and see how improvements can be made



Analyse your PQRS feedback reports and monitor your current quality metrics across Medicare and private payers

8. What is the Advanced Alternative Payment Model?

AAPMs are performance based payment methods that CMS will follow to reimburse physicians who care for Medicare beneficiary. CMS will release a list annually on the care models that qualify for AAPM incentives. Providers who participate in qualifying AAPMs will be eligible for APM payments and bonuses and are exempt from participating in MIPS. However, all providers will report under MIPS in 2017. CMS will take a decision on the clinicians who will qualify for APM status.

9. What are the eligibility criteria for participating in AAPMs? Providers will have to use certified EHR technology, base payments on quality measures akin to MIPS and shoulder monetary risk for financial losses incurred.

10. How do I prepare myself to participate in AAPMs? 

Choose quality measures that have a higher chance of success



Identify opportunities to improve patient care and achieve savings for payers



Implement clinical and financial strategies to help meet your chosen quality measures

Read More: https://www.billingparadise.com/blog/2016/11/16/macra-faqs/?pdf