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

 Erika Regulsky Tags: , , , , , , , , , , , Compliance
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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.

Measures

Individuals

Groups

Measure 1: Quality

✦ Claims ✦ QCDR
✦ QCDR ✦ Qualified Registry
✦ Qualified registry ✦ EHR Vendors
✦ EHR vendors ✦ CMS Web Interface (groups of 25 or more)
✦ Administrative claims (submission not required) ✦ CAHPS for MIPS Survey
✦ Administrative Claims (No submission required)

Measure 2: Resource use

✦ Administrative claims ✦ Administrative claims (No submission required)

Measure 3: Advancing care information

✦ Attestation ✦ Attestation QCDR
✦ QCDR ✦ Qualified Registry
✦ Qualified registry ✦ EHR Vendor
✦ EHR vendor ✦ CMS Web Interface (groups of 25 or more)

Measure 4: CPIA

✦ Attestation ✦ Attestation
✦ QCDR ✦ QCDR
✦ Qualified registry ✦ Qualified Registry
✦ EHR vendor ✦ EHR Vendor
✦ Administrative claims ✦ CMS Web Interface (groups of 25 or more)

<!--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

Click on the Image below to Enlarge:

MACRA-Frequently-asked-questions


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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.


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