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December 12, 2016

5 Essential Things to Know about MACRA

December 12, 2016


MACRA is almost upon us! We’ve written at length about all the ins and outs of this new rule, but we wanted to take a moment to review 5 of the most important things to know about MACRA and what this year will look like. Read on!

#1: The Quality Payment Program

Who qualifies? Providers (i.e. physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists) who bill Medicare more than $30,000 per year, or provide care for at least 100 Medicare patients. Providers who are new to Medicare in 2017 are not required to participate in 2017.

#2: The Quality Payment Program Start Date

For providers who are ready to start collecting performance data, the start date can be as early as January 1, 2017. But CMS has allowed providers to start at any time between January 1 and October 2. But regardless of when providers begin collecting data, it is due to CMS by March 31, 2018. All data collected in the first performance year will be the determining factor regarding payment adjustments beginning January 1, 2019.

#3: Participation Options

There are two options:

MIPS is designed for providers who are in traditional, fee-for-service Medicare. APM, however, is designed for those who participate in specific value-based care models.

#4: MIPS

Essentially, MIPS combines three CMS programs: Meaningful Use, the Physician Quality Reporting System, and the Value-Based Payment Modifier. For more on MIPS, feel free to look back through our previous blog posts on the topic.

#5: APM

Physicians who participate in an advanced APM may earn a 5% lump sum incentive payment annually from 2019 through 2024. They can also dodge MIPS reporting requirements and payment adjustments.

Is That It?

Definitely not! MACRA is a complex, detailed rule that we have covered in depth on this blog as 2017 drew nearer. If you’d like more information on MACRA, or if you’re looking for someone to help you navigate 2017’s billing and coding, contact us – we can help you focus on your practice instead of your paperwork!

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