MACRA – If you are not prepared your Medicare, and potentially all reimbursement, will likely be reduced.
MACRA makes 3 important changes:
- replaces the Sustainable Growth Rate (SGR) formula and the need for an annual year end “docfix”;
- links quality of care to reimbursement. Quality of care goals must be achieved via participation in either of the following programs:
- Merit-Based Incentive Payment System (MIPS) or,
- Alternative Payment Models (APMs) meeting MACRA eligibility criteria.
- creates MIPS (Merit-based Incentive Payment System) by combining 3 existing quality reporting programs (Physician Quality Reporting System, Value-based Payment Modifier, and Meaningful Use) with a new performance category called Clinical Practice Improvement Activities (CPIA).
Proposed rules enacting MACRA were issued May 9, 2016. Final rules are expected in November 2016.
MACRA related reporting by physicians is proposed to begin in January 2017.
How much will reimbursement be impacted?
- MIPS payment adjustments start at 4% in 2019 and gradually increase to 9% in 2022. Adjustments may be positive or negative. Until then you will see a .5% increase.
- If the APM is an advanced APM (AAPM), qualifying participants (QPs) will receive an annual 5% lump-sum bonus on their Medicare Part B payments 2019 through 2024. Beginning in 2026, QPs will receive a 0.75% increase in FFS payments.
Most physicians will likely participate in MIPS until more advanced APMs become available.
THIS IS FOR REAL AND WILL HAVE A SIGNIFICANT IMPACT ON YOU. MAKING THE RIGHT DECISIONS NOW WILL EFFECT HOW YOU PRACTICE AND HOW WELL YOU WILL BE COMPENSATED FOR THE REST OF YOUR CAREER.
For additional information and an evaluation of MACRA’s impact on your practice, please contact us. It will be our pleasure to serve you.