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The MACRA Final Rule for 2018: information for Medical Practices

December 19, 2017

MACRA-2.jpgThe Medicare Access and CHIP Reorganization Act (MACRA) of 2015 was intended to reward clinicians for value of care quality over volume – a departure from fee-for-service – by streamlining multiple quality programs under a new Merit Based Incentive Payments System (MIPS).  As an added incentive, participation in eligible alternative payment models (APMs) further qualified providers for earning bonus payments.

Key elements and provisions of the Final Rule

The final rule proposal will update payment policies, including rates, as well as quality provisions for any services included in Medicare’s Physician Fee Schedule (PFS) on or after January 1, 2018. This new calendar year should see a broader strategy for better quality, affordability, accessibility, innovation and patient empowerment. It has also been designed to be more user-friendly for smaller, independent and rural practices.

  • New feature: Virtual groups

Solo practitioners and other small practices eligible for their own MIPS, can now participate as a virtual group, submitting under group rules rather than as an individual. These would be made up of two or more combinations of Tax Identification Numbers consisting of solo practitioners and groups of 10 or fewer eligible clinicians coming together virtually.

  • Changes in weighted scoring

For the 2018 scoring period (with the 2020 payment year) is weighted at quality: 50 percent, and will drop to 30 percent in 2019 and beyond; with cost at 10 percent (will rise to 30 percent in 2019 and beyond.) Advancing care information (ACI) remains at 25 percent and improvement activities (IA) are 15 percent.

  • Exemption of more physicians from MIPS in 2018

The low-volume threshold has been increased from 100 to 200 Medicare Part B beneficiaries, with reimbursement limits of $90,000 of Part B charges this year, up from 100/ $30,000 respectively for 2017. These developments mean that a significant number of physicians will no longer have to participate.

  • Natural disaster considerations and provisions

For clinicians impacted by the hurricanes Harvey, Irma and Maria, as well as other natural disasters during 2017’s MIPS performance period, the final rule will automatically weight Quality ACI and IA at zero percent of the final score of the 2017 transition year

How providers can earn bonus points

Clinicians caring for complex patients are eligible to earn five bonus points added to their final MIPS score; practices with 15 or fewer providers (may earn  up to five points), or if they exclusively use the 2015 edition certified EHR (CERT) technology. (While the 2014 edition may still be used for the 2018 period, those using the 2015 edition will earn a 10 percent bonus.)

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MACRA and EHR challenges

One of the requirements for successful compliance with MACRA is the use of electronic health records (EHR) to handle the complex reporting tasks involved. Unfortunately, many practices found that their EHR systems’ functions were either too limited or took up more time and attention than intended, defeating its original purpose.

A recent study reported that while most practices use EHR or population health management (PHM) over 61 percent were dissatisfied with their systems’ functions relating to the performance of the Quality Payment Program (QPP). Such limitations could ultimately affect provider scores and ratings.

Working with a professional billing service

Practices who choose to partner with a professional medical billing service, such as M-Scribe Billing Services, LLC, can be relieved of some of the burden of MIPS complexities, while confident that MACRA reporting requirements are timely, accurate and fully compliant. M-Scribe can help take billing and coding time and guesswork out of the back office and free providers for what they do best: caring for patients. Contact them today at 1-888-727-4234 or email for a no-obligation analysis of your practice’s needs and revenue goals.


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