Are You Ready For MACRA?

The steady increase in healthcare costs was the push behind the federal government’s need to change the way that providers care for and interact with Medicare beneficiaries.  The goal: To decrease costs and improve patient outcomes. The result: MACRA. Instead of  being reimbursed based on codes and the number of services performed providers will now be “graded” based on the quality of care that they provide.  MACRA, the Medicare Access and CHIP Re-Authorization Act, was signed into law in 2015 - but will not be implemented until 2019. 

This may be misleading because, although the changes to reimbursement, positive or negative, will not start until 2019 the score that determines how you will be reimbursed in 2019 is based upon data that is collected in 2017

What you really need to know:

  • The old method of determining reimbursement  is now combined  into one Merit-Based Incentive Payment System (MIPS).  Eligible Professionals (EPs), physicians, practitioners and therapists) will be provided with a MIPS score based on their performance. 
  • You must select the required number of measures from each category that best works for your particular practice. Some categories are weighed either medium or high and your selection could help you to achieve higher scores. 
  • The performance categories and ratings are: 60% for Quality, 25% for Advancing Care Information and 15% for Improvement Activities. 
  • Starting in 2019, how you performed in 2017 will be the basic for determining  if you will lose or gain money for the Medicare claims that you bill.  Payment could range from -4% to +4% depending on your MIPS performance score. 
  • Your final MIPS performance score will aid in the creation of a unique fee schedule that will be used to determine what you are reimbursed on each claim that you bill. This means that similar providers, performing the same type of service, in the same general area of town, could be reimbursed completely different based on the MIPS score that was used to develop the fee schedule.
  • Providers that perform as expected, could be paid according to a fee schedule that would result in an increase or decrease, up to 9%, by the year 2022. 

Do not  IGNORE MACRA -  your wallet in 2019 will thank you.


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