The Medicare Access and CHIP Reauthorization Act (MACRA) which was signed into law in April 2015 will shift reimbursement from fee-for-service to pay for quality and value of services. MACRA rules apply only to medical billing for Medicare by physicians’ offices. Under the program, the U.S. Centers for Medicare and Medicaid Services (CMS) plans to use performance data collected in 2017 to make payment adjustments for 2019, though recent reports indicate that implementation will be delayed.
Physicians can choose from two value-based payment models under the new, two-track Medicare physician payment system:
- Alternative Payment Models (APMs) – MACRA supports physicians who opt for the new payment and delivery models approved by CMS.
- Merit-Based Incentive Payment System (MIPS) – MACRA retains a more flexible modified fee-for-service model which consolidates former reporting programs (Physician Quality Reporting System, Value-Based Modifier, Meaningful Use).
Most physicians are expected to start with MIPS. Those who participate in the APMs at certain threshold levels will be exempt from the MIPS.
According to CMS, MACRA’s potential positives are:
- Reimbursement based on value to patients, not volume
- Electronic Health Record (EHR) metrics focused on performance, not process
- More comprehensive care integrating multiple providers
Industry experts offer the following guidelines to help physicians prepare for compliance with MACRA’s new payment and quality reporting framework:
- Understand the basics: A recent Deloitte survey of physicians found that half of the respondents are unaware about MACRA and what the upcoming payment changes mean. Physicians should make an effort to learn the basics of the proposed models by visiting the CMS website and the website of the American Medical Association (AMA). They should also educate their team, including all stakeholders.
- Focus on quality: Under MACRA, 85% of total Medicare payments will be based on value of care. To enhance practice income, they should assess all the measures for which they report data and carefully choose and report metrics in high performance areas. Quality measures can differ by specialty.
- Evaluate technology: Technology is crucial for smaller practices to prepare for MACRA and meet the government’s changing reimbursement structures and regulations. They should meet Meaningful Use by implementing an EHR. Providers will need to report six measures from a list of nearly 300 to meet the regulation’s quality requirements. Not all EHR systems can report 300 quality measures. Therefore, practices should make sure that their current technology can report selected measures accurately.
- Create a long-term strategy: Physicians need to develop a long-term plan to demonstrate how they will add value to the patient experience in the future. They can start with clinical practice improvement activities, evaluation of resource use, and improvement of care information.
As physicians take concrete steps to succeed in MACRA’s new payment and quality reporting framework, professional medical billing services can be very helpful. A recent Black Book survey found that 91% of physician practices expect declining to negative profitability due to diminishing reimbursements and underutilized or inefficient medical billing and records technology. Partnering with an established medical billing company will ensure quality medical billing and payment collection processes using state-of-art technology to improve practice and revenue cycle management and promote MACRA readiness.