2017 will transform the way your practice approaches Medicare reimbursements and patient data.


The Medicare Access and CHIP Reauthorization Act (MACRA) doesn’t officially affect Medicare payments until 2019, but a lot is happening as the deadline approaches. Based on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule, 2017 will have a direct impact on MACRA’s 2019’s payment calculations.


Don’t feel bad if you don’t know what MACRA completely entails or what it means for your practice. Many people don’t. Between seeing patients and managing a practice, it’s difficult to stay apprised of every government mandate. However, it’s important to prepare for MACRA’s 2017 requirements as soon as possible.


MACRA’S background and what it entails


The act is a detailed, thorough set of guidelines and rules centering on Medicare clinicians. Put simply, it’s a comprehensive overhaul of previous Medicare payment regulations proposed by the CMS.


Passed by Congress in 2015, the act’s purpose is to reform Medicare payment to lower health care costs while maintaining quality medical care.


The series of payment changes are a part of MACRA’s proposed rule. The rule’s purpose is to replace the sustainable growth rate formula (or SGR) that was previously used as the standard equation to calculate exact Medicare payments to medical care providers.


MACRA’s new rule encompasses several pre-existing Medicare programs including Meaningful use, Value-based Payment Modifier, and Physician Quality Reporting System.


This rule establishes two new payment tracks, the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APM). Practices will decide where they fit best between the two tracks.


For a more detailed review of MACRA, view Allscripts’ “Beginners Guide to MACRA” and webinar series, or the CMS website.


What’s happening in 2017


Next year is important in the MACRA timeline. It will set the tone for Medicare payments by being the performance tracking year determining 2019’s reimbursement adjustments.


“MACRA’s Quality Payment Program (QPP) is the regulation that will implement a radical change in Medicare payments, moving from fee for service to fee for value,” says Allscripts Solutions Director of Regulatory Programs Jim Brulé.


Brulé says although the actual rates won’t be updated until 2019, clinic performances in 2017 will affect reimbursement rates.
Because 2017 determines the payment adjustments, it is important to know which payment track your practice qualifies to use.


What this means for your practice


As mentioned, your practice will follow a MIPS or APM track. These tracks help monitor clinic performance. A majority of practices will fall into the MIPS track, but some will use APMs.


MIPS will combine existing reporting systems and the EHR incentive program into one streamlined program. It will evaluate participants on quality, resource use, clinical practice improvement, and meaningful use of certified EHR technology, according to the CMS.
The second payment option, APMs, offers several methods to reimburse health care providers. To qualify to for an APM track, your practice would have to meet a set of requirements, including the use of certified EHR technology and quality measures.


“Unfortunately, whether their scores earn them an incentive or a penalty will not be known until later in 2018 after the performance period has closed. With no clear “finish line” in sight, practices will have to maximize their efforts to perform well on every measure until they get a sense of how the rest of the country performs,” says Brulé.


What to do now


Quality reporting of patient data will make a world of difference as you navigate through MACRA’s requirements. Practices that fail to report patient data or do so poorly will face Medicare payment penalties.
“Fundamentally, time is of the essence. Since even existing programs like Meaningful Use (which will be rebranded as “Accelerating Care Information” in MIPS) will see fundamental reporting changes, the sooner one gets their software upgraded and new reporting capabilities installed, the better,” says Brulé.


Additionally, Brulé says that MACRA requires “Eligible Clinicians” to participate in reporting processes. This includes nurse practitioners, physician assistances, and other certified nursing professionals, meaning a larger percentage of staff will be monitored.


It’s important to evaluate the effectiveness of your clinic’s existing EMR/EHR tools and billing software and to educate your staff on the payment track of your practice. The accurate and efficient retrieval and reporting of patient data is vital to comply with the MIPS and APM tracking.


Need the tools to prepare your practice for 2017? Contact us to see how PatientLink tools and software can help.