If you are physician or healthcare practitioner and you are at a loss on MACRA, then you are not alone. MACRA has been put in motion by the government and a good place to start is by getting familiar with the MACRA FAQ. There FAQs should give you a base knowledge of the requirements as you plan and prepare to fulfill them.
MACRA FAQ and Answers
Why is MACRA necessary?
MACRA is necessary because of systems in the past subject doctors to negative payment adjustments and unfair penalties. MACRA stabilizes the reimbursement landscape and regularizes penalties reducing it from 11%(which is outrageous) to 4%.
How do payments work
MIPS will be eligible for positive or negative Medicare Part B payment adjustments that start at 4% and gradually increase to 9%. This payment method will start in 2019 and go on until 2022. This payment distribution will be made on a sliding scale and will not be affected by the budget. I.e it will be budget neutral. Instead, the payment adjustment will be made on a sliding scale and based on:
- Physicians with a final score at the threshold will receive a neutral payment adjustment.
- Physicians with a final score above the threshold will receive a positive payment adjustment on each Medicare Part B claim in the payment year.
- Physicians with a final score below the threshold will receive a negative payment adjustment on each Medicare Part B claim in the payment year.
- Physicians with a final score in the lowest quartile will automatically be adjusted to the maximum negative adjustment on each Medicare Part B claim in the payment year.
MACRA is not just for Physicians. It’s also required for Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, and groups that include clinicians who bill under Part B. Individuals who bill Medicare more than $30,000 and anyone already part of an Advanced APM will also participate.
What if I don’t report at all?
Those who don’t report will not only have to pay the 4% fine but also face potential impact on their reimbursement, future job search efforts and lost reputation with potential patients.
If I work in a large organization, do I need to worry about preparing for MACRA?
Should I report as an individual or group?
MACRA defines a group as a single Taxpayer Identification Number (TIN) with two or more MIPS eligible clinicians, as identified by their individual National Provider Identifier (NPI), who have reassigned their Medicare billing rights to the TIN. If you don’t fit this requirement then you should report as an individual.
What about multi-specialty practices, should they report as a group?
Most practices find it beneficial to report as a group as reporting individually will be a tedious process. Reporting as a group makes it relatively easier to achieve measures, such as care coordination, that requires effective communication among providers, patients, and specialists. Everybody can participate in this.
How To Stay Prepared for MACRA Changes
Know your Status and keep track of it: The American Medical Association has a payment model evaluator that helps you know if you are qualified for or exempt from MIPS or Advanced AM tracks. You can also keep track of all MIPS and MACRA requirements to maximize your Medicare bonuses over time. These requirements will likely be updated on an annual basis so keeping track can help you meet and even surpass all requirements.
Meet current quality reporting program measures: The sooner you start meeting the existing program measures successfully, the better prepared you’ll be to earn a higher payment bonus once MIPS starts. MIPS will combine and then streamline existing incentive programs and performance determined payment into one. So if you already have these existing rules met, you’ll be off to a good start.
Target specific improvement areas: With this new reporting system, health organizations and practitioners might have to report on areas they don’t normally report on. Targeting specific areas to report on will help health organizations be proactive in gathering data in anticipation. This will make things easier and flow more smoothly.
Prepare for CPIA: The Center for Medicare and Medicaid is yet to release the specific requirements for certain categories such as clinical practice improvement activities but they will definitely consist of improving them so the more prepared health practitioners and organizations are the better.
With whispers that CMS will require CMQs to reflect accurate data, your practice or healthcare facility will benefit in other practice areas. With fewer responsibilities, your staff can focus on the different aspects and nuances of electronic clinical quality measures.