The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the Sustainable Growth Rate, and also introduced the Quality Payment Program which seeks to encourage clinicians to provide more comprehensive care through two tracks: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). CMS finalized the regulation in October 2017.
MIPS is the combination of the former Physician Quality Reporting System (PQRS), Meaningful Use (MU), and the Value-based Modifier, which have their final performance period in 2016. Each year, providers will receive payment adjustments based on their performance, which could be an incentive or penalty (in 2017, up to 4%).
It is composed of four scoring categories:
On the other hand, participation in Advanced APMs exempts a provider or group from MIPS reporting and payment adjustments. These are value-based contracts that include an element of financial risk, like shared losses. CMS desires to encourage more providers to participate in this track. In 2017, Medicare Shared Savings Program tracks 2 and 3, Comprehensive Primary Care Plus, and Next Generation Accountable Care Organizations are all included.
The rule will continue to evolve over time. We expect to see more measures around interoperability and patient outcomes, patient engagement, and increased flexibility in reporting. But for now, to get started, be sure to check out these resources:
Listen to a podcast, hosted by Alex Goulding, industry and government affairs specialist, to better understand the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and MIPS on small practices
Advanced APMs can keep you from being hit with MIPS penalties, but there are some questions you should ask yourself to see if it is the right path for your organization under MACRA.
Listen to a podcast, hosted by Zach Blunt, product manager of population health, to learn about the Comprehensive Primary Care Plus (CPC+) initiative, an Advanced APM that helps you avoid MIPS.
Listen to a podcast, hosted by David Heller, Greenway Health product marketing specialist, to learn about Advanced Alternative Payment Methods (APMs), the other pathway available to providers under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
You know the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is right around the corner, and under the legislation, clinicians will choose one of two payment pathways: the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).
In the healthcare industry, things don’t stay the same for long — including clinician reimbursements. Under the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), clinicians must choose between two new pathways to receive Medicare payments: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).
Big decisions are always stressful. But when it comes to your practice’s finances, the burden is even greater.
In short, the legislation means that changes are coming for your organization and the way you get paid. Here’s what you can expect.
Under the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), providers will need to choose one of two payment pathways: the Merit-based Incentive Payment System (MIPS) or eligible alternative payment models (APMs).
The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) will introduce reimbursement changes in 2019. However, 35 percent of providers aren’t familiar with MACRA or the new reimbursement programs.
To decide which payment pathway will ensure your practice continues to receive appropriate reimbursement and stay profitable, there are a few important questions to consider.
How will MACRA affect the way you get paid?