Do I Have to Participate in Macra

Do I Have to Participate in Macra

So, what is all this MACRA stuff everyone keeps talking about? Are you planning to ignore it and maybe it will go away? Think maybe it doesn’t apply to you? Unfortunately, it looks like MACRA is here to stay, and there are bonus incentives you should know how to maximize.

What is MACRA?

MACRA, also known as the Medicare Access and CHIP Reauthorization Act is the law that will end the sustainable growth rate formula that threatened to cut Medicare reimbursement every year. A portion of this law combines the Meaningful Use (MU), Physician Quality Reporting System (PQRS), and the Value-Based Modifier into the new system known as the Quality Payment Program (QPP).

When Will MACRA Affect Me?

The date collection for the Quality Payment Program (QPP) begins in 2017 and will affect the physician’s Medicare reimbursement for payment year 2019. There is a potential to earn up to a 5% positive payment adjustment or a 4% negative payment adjustment if you choose not to participate.

Are there Bonus Incentives for Participating in MACRA?

There are two different ways to participate in the Quality Payment Program:

  • Advanced Alternative Payment Model (APM)
  • Merit-based Incentive Payment System (MIPS)

Participating in APM

If you are participating in an Advanced Alternative Payment Model (APM) you will earn the 5% bonus incentive in 2019 and the reporting will depend on the requirements from the Advanced APM.

If you are not part of an APM, then you will report MIPS data, along with 95% of all other providers.

Participating in MIPS

Centers for Medicare & Medicaid Services (CMS) has made it very easy to participate this year in MIPS, with the goal to encourage as much participation from as many providers as possible. You have four options to report under MIPS:

  1. Refuse to participate: If you do not submit any data, you will automatically receive a 4% negative payment adjustment.
  2. Submit something. Anything: You can submit as little as one quality measure or clinical improvement activity for one patient. In this case, you will not earn a positive payment adjustment, but you will not receive the negative payment adjustment.
  3. Submit a partial year of data: You can submit 90 days of data to Medicare and earn a neutral to positive payment adjustment.
  4. Go all in: Submit a full year of quality data to earn a positive payment adjustment.

The bonus incentive you could possibly earn will depend on the quality of the data you submit. There is a scoring mechanism in place to evaluate the data submitted.

So, what type of data are they looking for? There are four components to MIPS data.

  1. Quality Measures – these measures are very like the PQRS measures already in place.
  2. Clinical Improvement Activities – this is a brand-new category of clinical measures to improve patient care.
  3. Advancing Care Information – these are very close to the Meaningful Use requirements
  4. Cost – this will replace the Value-Based Modifier. The cost category will be calculated by CMS. This category will carry a 0% weight in your 2017 MIPS score.

For more detailed information on the Quality Payment Program and the specific MIPS measures, the QPP website is a very good resource.

Kelli Rain, CPC, CPMA
Director of Coding