A promise to fundamentally change the way of evaluating and paying for health care was signed into law on April 16, 2015 with a bipartisan legislation called Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
What does MACRA do?
- Repeals the Sustainable Growth Rate (SGR) Formula
- Changes the way that Medicare rewards clinicians for value over volume
- Streamlines multiple quality programs under the new Merit-Based Incentive Payments System (MIPS)
- Provides bonus payments for participation in eligible alternative payment models (APMs)
The Merit Based Incentive Payments System (MIPS) integrates parts of the Medicare Electronic Health Record (EHR), the Value Modifier (VM or Value-Based Payment Modifier), and the Physician Quality Reporting System (PQRS) incentive programs into one. Under MIPS, Eligible Professionals (EPs) will be measured and paid based on:
- Resource Use
- Clinical Practice Improvement
- Advanced Care Information
Alternative Payment Models (APMs) provide a new way for Medicare to compensate healthcare providers for the support they give to Medicare beneficiaries. Most providers who take part in APMs will also be subjected to MIPS but will receive favorable scoring – with correspondingly higher reimbursement rates. Providers participating in the most advanced APMs may be designated as Qualifying APM Participants (QPs), which are not subject to MIPS. They may be eligible for:
- Annual 5% lump-sum bonus payments from 2019 through 2024;
- Beginning in 2026, higher annual premiums (for some participating providers); and
- Increased flexibility through physician-focused payment models
MIPS Consulting and Implementation
|Category||What do you need to do?|
|QualityReplaces the Physician Quality Reporting System (PQRS).||
Most participants: Report up to 6 quality measures, including an outcome measure, for a minimum of 90 days.
Groups using the web interface: Report 15 quality measures for a full year. To submit data as a group through the CMS Web Interface, you must register your group between April 1, 2017 and June 30, 2017.
Groups in APMs qualifying for special scoring under MIPS, such as Shared Savings Track 1 APM or the Oncology Care Model one-sided risk APM: Report quality measures through your APM. You do not need to do anything additional for MIPS quality.
|Advancing Care InformationReplaces the Medicare EHR Incentive Program, also known as Meaningful Use.||
Fulfill the required measures for a minimum of 90 days:
Choose to submit up to 9 measures for a minimum of 90 days for additional credit.
For bonus credit, you can:
You may not need to submit advancing care information if these measures do not apply to you.
|Improvement ActivitiesNew category.||
Most participants: Attest that you completed up to 4 improvement activities for a minimum of 90 days
Groups with fewer than 15 participants or if you are in a rural or health professional shortage area: Attest that you completed up to 2 activities for a minimum of 90 days.
Participants in certified patient-centered medical homes, comparable specialty practices, or an APM designated as a Medical Home Model: You will automatically earn full credit.
Participants in certain APMs under the APM scoring standard, such as Shared Savings Program Track 1 or OCM: You will automatically receive points based on the requirements of participating in the APM. For all current APMs under the APM scoring standard, this assigned score will be full credit. For all future APMs under the APM scoring standard, the assigned score will be at least half credit.
|CostReplaces Value-Based Modifier.||No data submission required. Calculated from adjudicated claims.|
Maximize the services offered by our care specialists to assist your practice in applying the Quality Payment Program.
In order for providers to optimize payments under Advanced APMs and MIPS, eligible professionals should focus their efforts on these three (3) areas immediately:
- Annual Wellness Visit Programs
The Annual Wellness Visit (AWV) is a preventive benefit offered to anyone with Medicare
Part B to stay healthy and productive.
The Medicare Annual Wellness Visit (AWV) identifies high-risk over-utilizers, provides powerful tools to support patient wellness, and offers a valuable new revenue source. Working closely with hospitals, PHOs, ACOs, clinics, and physicians, Phoenix Healthcare Advisors, LLC has developed a comprehensive solution that enables hospitals and their primary physicians to benefit whether in a short term or long term.
Open our Annual Wellness Visit page to learn more.
- Chronic Care Management Program
MACRA’s essential component is the proactive and frequent care management of patients with multiple chronic conditions provided under Chronic Care Management (CCM).
CCM is the non-face-to-face services provided to Medicare beneficiaries who have two or more significant chronic conditions. In addition to office visits and other face-to-face encounters (billed separately), these services include communication with the patient and other treating health professionals for care coordination (both electronically and by phone), medication management, and being accessible 24 hours a day to patients and any care providers (physicians or other clinical staff).
The creation and revision of electronic care plans are also a key component of CCM.
Visit our Chronic Care Management page to learn more.
- Transitional Care Management
Transitional care management (TCM) provides the supervision and coordination of health care services for patients transitioning from an inpatient hospital to community setting. Qualified providers are encouraged to provide the necessary resources and administration to help prevent patients from being readmitted.
Visit our Transitional Care Management page to learn more.
Let Us Know How We Can Help You in Participating in the Quality Payment Program (QPP). Reach Us Today!