By understanding more about the changes implemented by the latest Medicare reform, medical specialists can ensure their organization remains in compliance. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) sets out the refined standards for billing patients and seeks to reward specialists for providing quality of service. In this latest post, we’ll provide more in-depth details on MACRA and the changes the legislation requires from the modern practice.

What is MACRA?

MACRA is the legislation that has introduced changes to the clinician payment system under Medicare. The act displaces the Sustainable Growth Rate formula, which determined reimbursement rates for clinicians and replaced it with payments based on the quality of care and the effectiveness of the care provided. This means that a growing percentage of the total payment will be based on quality of care and not volume of patients seen by the medical specialist.

What is the Merit-based Incentive Payment System (MIPS)?

MIPS works to combine three of the Medicare quality reporting systems – Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VBPM), and Meaningful Use (MU) – into one versatile tool. In addition, as part of the MACRA legislation, MIPS also includes the Improved Activities (IA) category for payments. The scores from the PQRS, the VPBPM, MU and the IA to provide the specialist with a final score for their performance. This final score is then used to determine adjustments to the specialist’s payments based on their work.

Starting in 2019, those participating in MIPS are eligible for positive or negative Medicare Part B payment adjustments. These adjustments start at 4% and gradually increase to 9% in 2022.

What is Pick Your Pace?

Because of the complex nature of the new reporting and payment systems, the U.S. government has implemented a process to help care specialists as they adapt to the MACRA reform. Pick Your Pace is a critical part of this process. The Pick Your Pace step for Medicare reporting will be available throughout 2017. It presents clinicians with four distinct options to help them mitigate negative payment adjustments in the coming years. These options include:

  • Test

As part of the test option, clinicians will have to report at least one quality measure, one improvement activity or follow the required ACI measures.

  • Participate in an Advanced APM

Those who qualify and enter into an advanced APM will be exempt from MIPS adjustments

  • Full Participation

Clinicians can also report on all quality measures, all required improvement activities, and all required ACI measures for a full 90-day period. This improves the clinician’s chance of achieving a moderate positive payment adjustment for 2019.

  • Partial Participation

Clinicians can choose to report on one quality measure, more than one required improvement activity and more than one required ACI measure. This will then improve the chance they will receive a small positive payment adjustment in 2019.

No registration is required for the Pick Your Pace program. However, those opting to report via a CMS Web Interface must do so by June 30, 2017.

By understanding more on MACRA and the changes implemented in Medicare, clinicians can ensure they reach their objectives for the coming years. To discuss this complex subject with a specialist, call our team today at 800-333-1033 or