What to Know Now That CMS Has Released MACRA Final Rule

The Centers for Medicare and Medicaid Services (CMS) recently released its final rule regarding the Medicare Access and CHIP Reauthorization Act (MACRA), a revolutionary payment system for Medicare physician fees proposed to replace the sustainable growth rate formula in an effort to modernize the system and make it more streamlined. The ruling serves to finalize MACRA’s Quality Payment Program, the goal of which is to lessen the administrative stress placed on doctors so that they may be able to better concentrate on patient care and add more value to these newer models. The intent is to get all clinicians on board working together on this initiative so that they can implement this Quality Payment Program within a time frame that works for them.

MACRA’s rulings can understandably get a little complicated and convoluted, so let’s go over some key points and explain them all in detail.

Who qualifies for the program? If you are a physician, PA, NP, anesthetist, or clinical nurse specialist that bills Medicare for more than $30,000 per year or provides care for at least 100 patients who have Medicare, you qualify for MACRA.

When does it start? January 1, 2017 was the initial start date, but you can begin anytime between now and October 2, 2017. Data collection is due to CMS by March 31, 2018, with payment adjustments taking place on the first of January, 2019.

What are the participation options? Provider participation can take two forms: the Merit-Based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (APM). MIPS is for health care providers who offer traditional, fee-for-service Medicare. Advanced APM is for providers taking part in value-based care models that are unique to their applications.

How can small practices participate? Because small, independent practices can often get left behind in these new rulings, CMS has made special requirements for them. Those who bill for less than $30,000 on Medicare or have fewer than 100 Medicare patients do not have to participate this year. Another available option is for small practices and solo practitioners to come together and submit combined MIPS data. Doctors who provide services in underserved areas or who operate in practices of fewer than 15 can take advantage of the allotment of $20 million a year for five years for training and education.

What makes the final rule so streamlined? The result of the final rule is a more unified program, featuring five critical changes, including:

  • Flexible first-year options
  • Allowance of low-volume threshold for small practices
  • Advanced APM as a standard to promote participation in value-based care models
  • Makes “all-or-nothing” EHR requirements easier to follow
  • Creates the medical home model in an effort to promote care coordination

Overall, the response to the final ruling has been positive, particularly in regards to the American Medical Association. To learn more about the above points, visit the Quality Payment Program here. The final ruling is still in its infancy stages, with the CMS still planning on hosting listening and learning sessions as a sounding board for future proposed changes.

Contact Medical Healthcare Solutions

To learn more about how MACRA affects your practice and how we can help you streamline your own business, contact us at 800-762-9800. We help providers in a variety of specialties, including cardiology, family practice, general surgery, internal medicine, obstetrics and gynecology, pediatrics, podiatry, psychiatry, pulmonary, gastroenterology, neurosurgery, ophthalmology, urology, student health services and more. We bring decades of medical billing experience and service to the healthcare industry to help ensure the highest standard of service.