10 questions about MACRA everybody

wants to know the answer for!

The Medicare Access and CHIP Authorization Act, (MACRA), has been met with
widespread relief and a tad bit of suspicion. As always conspiracy theories and
unanswered questions are in the air. Here are 10 major questions that everybody
wants an answer for.
1. What exactly is MACRA?
The Medicare Access and CHIP Authorization Act, (MACRA), will permanently
replace the dreaded Sustainable Growth Rate formula for determining payments.
MACRA seeks to:

Provide payments based on quality and outcomes rather than volume

To consolidate major incentive programs like PQRS, value based payment

modifier, Meaningful Use and the Medicare Electronic Health Record
incentive program into one single, comprehensive framework. Though the
existing incentive programs will be retired, the Merit Based Payment System
(MIPS) will retain the foundational ideas of the current quality reporting
programs.

Health information technology will play a major role

2. How will MACRA impact payments?

There are 2 paths for payment in the MACRA legislation.

The Merit Based Payment System (MIPS)

Alternative Payment Models (APMS)

3. Tell me more about MIPS

Eligible clinicians will be evaluated based on 4 categories:
Quality- based on the existing PQRS system
Resource use: based on the Value based payment modifier model
Advancing Care Information: which is similar to MU mandates
Clinical practice improvement categories
The scores for all the measures will be rolled up into a composite performance
score. Once the composite performance score is arrived at it will be compared
against a threshold which will be used to make payment adjustments.
MIPS payment adjustment at a glance

Submission

Category scoring

Calculation of composite performance score

Comparison between composite performance score with composite

performance score threshold

Payment adjustments

4. Am I eligible to participate in MIPS?

You are eligible if you are a physician, registered nurse practitioner, clinical nurse
specialist, certified registered nurse anesthetist. Going forward, the secretary may
broaden the eligible clinician group to make occupational therapists, speech
language pathologists and nutritional professionals to become eligible to participate
in MIPS as well.

5. Will MACRA eliminate fee for service?

MACRA preserves the fee for service model. Physicians who follow the fee for
service model can participate in the MIPS program.
6. What are the data submission requirements of MIPS?
MACRA intends to follow a single, unified data submission method for all the
performance categories. To achieve this goal MIPS expands on the existing quality
measures and simplifies the data submission process.

The submission guidelines for individuals are:

Measure 1: Quality

Claims

QCDR

Qualified registry

EHR vendors

Administrative claims (submission not required)

Measure 2: Resource use

Administrative claims

Measure 3: Advancing care information

Attestation

QCDR

Qualified registry

EHR vendor

Measure 4: CPIA

Attestation

QCDR

Qualified registry

EHR vendor

Administrative claims

Data submission options for groups:

Measure 1: Quality

QCDR

Qualified Registry

EHR Vendors

CMS Web Interface (groups of 25 or more)

CAHPS for MIPS Survey

Administrative Claims (No submission required)

Measure 2: Resource use

Administrative claims (No submission required)

Measure 3: Advancing care information

Attestation QCDR

Qualified Registry

EHR Vendor

CMS Web Interface (groups of 25 or more)

Measure 4: CPIA

Attestation

QCDR

Qualified Registry

EHR Vendor

CMS Web Interface (groups of 25 or more)

7. What should I do prepare myself for MIPS?

If you are already reporting quality measures under the existing incentive
programs identify and focus on your high performing quality measures

Evaluate and educate your staff on QRUR (quality resource and use
report) by CMS and see how improvements can be made

Analyse your PQRS feedback reports and monitor your current quality
metrics across Medicare and private payers

8. What is the Advanced Alternative Payment Model?

AAPMs are performance based payment methods that CMS will follow to reimburse
physicians who care for Medicare beneficiary. CMS will release a list annually on the
care models that qualify for AAPM incentives. Providers who participate in qualifying
AAPMs will be eligible for APM payments and bonuses and are exempt from
participating in MIPS. However, all providers will report under MIPS in 2017. CMS
will take a decision on the clinicians who will qualify for APM status.
9. What are the eligibility criteria for participating in AAPMs?
Providers will have to use certified EHR technology, base payments on quality
measures akin to MIPS and shoulder monetary risk for financial losses incurred.
10. How do I prepare myself to participate in AAPMs?

Choose quality measures that have a higher chance of success

Identify opportunities to improve patient care and achieve savings for payers

Implement clinical and financial strategies to help meet your chosen quality
measures

Read More: https://www.billingparadise.com/blog/2016/11/16/macra-faqs/?pdf