With the complex data sharing and reporting requirements of value-based payments and the Medicare Access and CHIP Reauthorization Act (MACRA), more and more physicians are opting to outsource medical billing. Outsourcing revenue cycle management (RCM) allows them to refocus on patient care and clinical service delivery.
To participate successfully in the complex payment programs under MACRA, physicians need to have a clear idea about Medicare payment reform in general, the MIPS track for payment and ACI. However, the results of the Physicians Practice 2017 Technology Survey results revealed that about 50% of respondents do not understand Advancing Care Information (ACI) Guidelines, a section in the Merit-based Incentive Payment System (MIPS) track of MACRA.
The Medicare Access and CHIP Reauthorization Act (MACRA) offers two service-reimbursement tracks for physicians: the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) such as Medicare accountable care organizations (ACOs). The Advancing Care Information (ACI) Performance Category replaces the electronic health record (EHR) Meaningful Use program. The Physicians Practice survey showed that while 38 percent did not understand the Quality Payment Program in general, 28.4 percent said they did not know the difference between ACI and Meaningful Use.
Under Meaningful Use, eligible clinicians had to meet thresholds for each measure. ACI is structured differently from Meaningful Use, though they have similar metrics. Unlike Meaningful Use, ACI includes clinical performance as part of a clinician’s base score.
- The ACI category score consists of two parts: the base score and the performance score.
- Eligible clinicians need to report on the base measures, which are a set of five required measures.
- For the 2017 transition year, eligible clinicians can report on a set of four base measures.
- Eligible clinicians can increase their score by reporting on additional measures.
- Eligible clinicians can choose one of the following reporting methods per performance category: a qualified registry, qualified clinical data registry (QCDR), electronic health record (EHR), CMS Web Interface, or attestation.
- If eligible clinicians choose to report as a group, all performance categories must be reported as a group and will be scored as a group.
- From January 2018, eligible physicians and hospitals are required to use 2015 edition certified EHR technology (CEHRT).
- Eligible clinicians without an EHR are allowed to participate in MIPS, but they will not be eligible for any of the points in the ACI category.
How ACI Scoring Works
- The base score assesses if a clinician performed the measure (activity) and is achieved by reporting the required base measures. Clinicians will receive 50 points for attesting to the base measures
- Failing to report any one of the base measures will result in a base score of zero and an ACI performance category score of zero.
- The performance score measures how the clinician performed on an individual measure and assigns up to 10 points per measure based on the performance rate (numerator/denominator).
- In 2017, physicians have nine performance score measures to choose from, including secure messaging, patient-specific education, and immunization registry reporting.
- Three of the required base measures can be included in the performance score.
- Clinicians do not need to report a certain number or percent of patients in order to receive points within the ACI category. They are scored based on their individual performance.
- Performance score can be increased by reporting on additional measures.
- The performance score allows clinicians to earn up to an additional 90 percentage points toward their ACI category score.
- The ACI category score is capped at 100.
- For 2018, small practices will get a 5-point bonus and those that care for complex patients will get a 3-point bonus.
As clinicians can attain the full (ACI) score with a combination of the different measures, they can focus on the measures that will help them achieve the highest percentage.
The change to value-based payment models requires software upgrades and evolving compliance regulations, and this makes outsourced medical billing services a practical option for small and medium-sized healthcare organizations. Partnering with an experienced medical billing company can help practices meet regulatory challenges and ensure smooth workflow.