In 2015, the government implemented the Medicare Access and CHIP Reauthorization Act (MACRA) to update the standards for patient billing and to reward healthcare facilities that were providing outstanding patient care.
This quick overview of MACRA can provide you with the knowledge to take advantage of the changes necessary to remain in compliance.
At its core, MACRA introduced five major changes, which include:
- Replacing the sustainable growth rate formula
- Rewarding clinicians for quality instead of volume
- Organizing quality programs under a merit-based incentive payments system
- Providing bonus payments to clinicians that take part in eligible alternative payment models
- Removing social security numbers from Medicare cards before April 2019
The biggest takeaway is that reimbursement rates under MACRA are determined by the quality of care and service that clinicians provide. Value is now rewarded over volume.
How Does MIPS Work?
The Merit-Based Incentive Payment System (MIPS) organizes the Value-Based Payment Modifier, Physician Quality Reporting System, Improved Activities, and Meaningful Use tools under one quality reporting system.
Value and service are determined by tallying the scores from each of these tools to arrive at a total score that reflects a clinician’s performance.
The composite score is based on the quality of service, the use of resources, clinical practice improvement activities, and purposeful use of certified electronic medical record (EMR) systems.
The score ranges from 0 to 100.
Beginning in 2019, clinicians that achieve high scores are eligible for positive adjustments to their specialist’s payments under Medicare Part B. Negative adjustments are made for clinicians with low scores. The floor adjustment is 4 percent, which increases to 9 percent in 2022.
It’s important to remember that clinicians can receive three types of adjustments: payment bonus, payment penalty, or no payment adjustment.
What Are Alternative Payment Models?
Clinicians that participate in alternative Payment Models (APMs) such as Bundled Payment Models are eligible to receive more favorable scores and higher reimbursement. They are also exempt from the MIPS requirements.
To quality for an APM, healthcare providers must use certified EMR systems, and report comparable quality measures to the ones required under MIPS.
How Does EMR Help with MACRA?
With all the new rules and regulations under MACRA, healthcare providers are under a lot of stress to get things right.
A certified EMR system can ease that burden by helping boost performance scores by helping in areas that contribute to that score, including:
- Providing patients with access to medical records through portals
- Organizing patient referrals
- Exchanging information with other medical facilities
- Allowing patients to receive electronic prescriptions
Part of the performance scores under MACRA relates to how often patients interact with their medical records through an EMR system, and how often healthcare providers use specific functions in the EMR system.
MACRA Is Evolution
As with many other changes in the medical industry, MACRA is the next step in providing quality healthcare. If you need more information, call our team today at 800-333-1033.