What are MACRA and MIPS?
MACRA and MIPS, also known as The Medicare Access and CHIP Reauthorization Act of 2015, are poised to drive health care delivery and payment reform. As a result, this change affects clinicians, health systems, Medicare, and other government and commercial payers.
On May 9, 2016, the US Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would implement key features of this law. One of these notable changes is the Merit-based Incentive Payment System (MIPS). It’s important to know that MIPS applies to all qualified clinicians that Medicare pays under the Physician Fee Schedule (PFS). MIPS also incentivizes these clinicians to participate in Advanced Alternative Payment Models (APMs).
The Proposed Rule
The proposed rule’s release gives stakeholders more information to assist in planning their MACRA strategies. Some of the questions facing clinicians and healthcare are:
- Which payment method will be the best fit for our practice/organization now? In the next five years? In ten years?
- If we choose MIPS, do we have the people, processes, and technology in place to accurately collect and report data on the measures? Also, how can we help clinicians perform well on each one to receive optimal payments?
- Suppose we choose to invest in APMs. Given our current payer mix, is it possible to meet the revenue or patient-count thresholds required to qualify for APM incentive payments? Also, what about higher payment updates? Furthermore, are we experienced and successful at managing risk under these Advanced APMs? Finally, what types of Advanced APM arrangements will be most beneficial for us?
What does this mean for my practice?
MACRA overhauls Medicare’s payments to clinicians by creating strong incentives for them to participate in APMs. Consequently, these APMs require financial risk-sharing for a broad set of health services designed to improve quality care. As a result, clinicians who are not qualified for these models will need to report their performance. There are four categories to report on: quality, resource use, Health Information Technology (HIT), and clinical practice improvement. Over time, performance measures the costs associated with a clinicians’ practice. Then, referral patterns will grow to 30 percent of the performance formula. Together, these policies will encourage a much stronger focus on patient care quality and total associated cost.
How can MACRA affect revenue for my practice?
MACRA puts significant revenue at stake for hospitals, health plans, and other organizations that employ clinicians paid through Medicare. Also, the incentives could create opportunities for insurance companies to enter into new arrangements with medical providers. As a result, this will set the stage for similar initiatives in other government programs.
If your practice isn’t ready for MACRA and MIPS, Give us a call and learn how we can maximize your Medicare payments.
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