10 Questions About MACRA Answered

  1. What is MACRA?

MACRA is an acronym for the Medicare Access and CHIP Reauthorization Act. CHIP stands for the Children’s Health Insurance Program. MACRA is a landmark legislation that outlines a value-based approach for the reimbursement of physicians participating in the Medicare Part B program. MACRA focuses on adjustments in payment based on risk, cost, and quality among others.

  1.  Who is required to participate in MACRA?

Clinicians who have opted for the Advanced Alternative Payment Model (APM) are already part of the Quality Payment Program. In addition, eligible clinicians are required to participate (or risk a negative payment adjustment in 2019) if they participate in the Medicare Part B program and:

  •      Bill more than $30,000 per year in allowed charges
  •      Care for 100 or more patients

Eligible clinicians who are first-year participants in Medicare Part B and fall outside the minimum thresholds listed above are exempt from participation in year one.

  1.  What are the payment models in MACRA?

There are two payment models under MACRA – MIPS and APM.

MIPS (Merit-Based Incentive Payment System): This is the track an estimated 90 percent of physicians, clinical nurse specialists, nurse practitioners, physician assistants, and certified registered nurse anesthetists will take. Eligible clinicians can opt for one of three reporting choices in the first year:

  •      Report a single quality measure or CPIA, or ACI for 90 days
  •      Report more than one quality measure, CPIA, or ACI for 90 days
  •      Report full MIPS data for the entire calendar year (six quality measures including at least one outcome measure)

CPIA = clinical practice improvement activities

ACI = advancing care information

APM (Advanced Alternative Payment Model):  Clinicians who receive 25% of payments or see 20% of patients through APM qualify for this payment model.

  1.  What is the timeline for MACRA implementation?
  •      The first performance year for MACRA began on January 1, 2017.
  •      The deadline for minimum reporting requirements (one quality measure for 90 days) was October 2, 2017 (failure to do so will result in a penalty or negative adjustment in the clinician’s 2019 reimbursement)
  •      The deadline to report collected data is March 31, 2018 (depending on performance, this could qualify clinicians for a small positive adjustment in payment or a bonus)
  1.  What are the performance categories in MACRA?

There are four performance categories in the MIPS payment model. The clinician’s score in each of these categories will be used to calculate a composite score. The performance threshold for each of these categories will be set by CMS based on the mean score in the preceding year. The MIPS scoring categories are:

  •      Quality
  •      CPIA
  •      ACI (previously Meaningful Use)
  •      Cost (excluded in 2017)
  1.  How will MIPS scores be calculated?

For the first performance year (2017) the four MIPS categories will receive the following weight:

Quality – 60 percent

CPIA – 15 percent

ACI – 25 percent

Cost – will be evaluated from 2018 onwards

  1.  How can MIPS eligible clinicians avoid negative payment adjustments?

By meeting the minimum reporting requirements (one quality measure for 90 days in 2017). Failure to do will lead to a negative payment adjustment of up to 4 percent in 2019. CMS estimates that 9 out of 10 eligible clinicians will receive a neutral or positive payment adjustment based on their MIPS score.

  1.  Can eligible clinicians earn a bonus?

Yes. Based on their composite MIPS score, some eligible clinicians may qualify for a positive payment adjustment or bonus for exceptional performance. Under the APM payment track, a 5 percent incentive is possible.

  1.  Will the MIPS score be reported publicly?

Yes. Every eligible clinician’s composite MIPS score will be made public on the Physicians Compare website and be available to third-party vendors and patients.

  1.  Where can eligible clinicians obtain further information about MACRA?

Further information is available on the CMS Quality Payment Program website (https://qualitypaymentprogram.cms.gov/). Eligible clinicians can also consult a MACRA expert to ensure they meet minimum reporting requirements.

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