What’s New in MACRA 2018?
With the introduction of MACRA (The Medicare Access and CHIP Reauthorization Act) in 2017, healthcare reimbursement moved from a fee-per-service model to a value-based payment model. The transitional period will last three years and 2018 will be year 2. The CMS has recently released MACRA requirements for 2018.
In the first year of MACRA implementation (2017), the two payment tracks – MIPS and APMs – were incompletely understood. There was some hope that the CMS would repeal the Act, but once this hope faded, there was a scramble to comply with the requirements of MACRA and avoid negative adjustments in reimbursement in the payment year 2019.
There are some changes in the Quality Payment Program in Year 2. Here’s what’s you need to know about MACRA 2018.
Exceptions and Eligibility
- Eligible clinicians with $90,000 or less in allowed charges for Part B or less than 200 beneficiaries are excluded in Year 2 (this has been increased from $30,000 and 100 beneficiaries in the first year)
- Extreme, uncontrollable circumstances will be excluded in Year 2, including retroactively for Year 1
- Small practices may qualify for hardship exception under the ACI category
- The ACI performance category will have 0 percent weighing in Year 2 for ASCs in the MIPS payment model
- Hospital-based eligible clinicians may qualify for hardship exceptions in the MIPS payment model under another Act (21st Century Cures)
What’s New in the Quality Payment Program in Year 2 (2018)?
- Option to form a virtual group to participate in MIPS
- Performance threshold raised to 15 points (increase from 3 points in the first year)
- Weight of 10 percent to the Cost category to weigh 10 percent
- Quality performance category to weigh 50 percent for the payment year 2020 (performance year 2018) and 30 percent for the payment year 2021 (performance year 2019)
- More flexibility for participation in AAPMs with a more flexible qualifying nominal amount standard (8 percent) and changes in the Medical Home Models requirements and also easier participation when Advanced APMs start or end mid-year.
New MACRA Incentives in 2018
- Extra points for 2015 CEHRT use
- Extra points for treating complex patients (maximum 5 points)
- Extra points for small medical practices (maximum 5 points)
- Extra points in the category of Quality for small practices unable to meet requirements for data completeness (maximum 3 points)
- Greater incentive for participation in APMs by eligible clinicians