The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) changed how Medicare Part B providers would be paid.
Replacing the volume-based payment system, MACRA is a performance-based system that rewards providers that give patients great value and outstanding service and care.
Under MACRA, healthcare providers are eligible to join the Merit-Based Incentive Payment System (MIPS), which combines three Medicare programs into one single payment program.
How MIPS Works
In the past, Medicare Part B programs had three payment options: the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program.
MIPS streamlines those programs into one performance-based payment system with four categories that are combined for a MIPS Final Score that determines Medicare Part B payment adjustments.
The categories that earn points under MIPS include:
- Quality – This category counts for 60 percent of a provider’s final score and replaces the PQRS. It judges providers based on the relevant use of medical resources, level of patient safety, workplace efficiency, overall patient experience, and coordination of care.
- Advancing Care Information (ACI) – This category counts for 25 percent of a provider’s final score and replaces the EHR Incentive Program. It measures how effectively providers use EHR systems, especially as it relates to patient access to medical records, and patient/provider communication.
- Improvement Activities – This category counts for 15 percent of a provider’s final score and measures participation in activities such as patient safety, coordinating care, and increasing health information access for patients.
- Resource Use – This category doesn’t have a value and is not currently used in the provider’s final score, although that’s expected to change. It replaces the VM category and analyzes Medicare claims to determine how well providers use resources.
How Does MIPS Impact Payments?
MIPS payment adjustments are based on a provider’s performance for the previous two years, so providers that were evaluated in 2017 will not receive their payments until 2019.
Providers can earn from 0 to 100 points on their final MIPS score, and the higher the point total the higher the positive adjustment.
In 2017, providers that earned from 4-to-70 points became eligible for a positive adjustment. Providers that earned 70 or more points also became eligible for an exceptional performance bonus, which is paid from a fund of $500 million dollars.
Providers that earned 3 points will not earn an adjustment, and providers that earned 0 points – which means they didn’t take part in the program – will have a negative payment adjustment of 4 percent.
Using EMR Systems to Boost Scores
The ACI category is 25 percent of a provider’s final MIPS score, and one of the main components of this category is the effective use of EMR systems.
Providers that want to maximize their scores must take advantage of the most up-to-date EMR systems on the market.
Whether it’s providing access to patient portals, enabling the processing of electronic prescriptions, or simplifying online communication between doctor and patient, EMR systems don’t just boost your MIPS score, they significantly enhance the patient experience.
If you’d like to learn more about EMR systems, contact Raintree Systems online or call us at 800-333-1033.