Are You Ready for (MACRA)?

Posted by Lauren Lau on November 29th, 2019

MACRA is Coming in 2019

How you and your practice get paid is soon going to change. The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, is remodeling the way providers are reimbursed for Medicare services. While this may not affect everyone who bills for Medicare services, it will greatly impact smaller offices and those not equipped with the proper software and Electronic Health Records systems (EHR). The change will force those practices that are eligible for the program to adapt or outsource their billing to a medical billing company who can support the technology needed to report the information correctly.

MACRA will be re-introduced in 2019, and will be a significant change in healthcare reform as a new model for Medicare reimbursement. The current model reimburses the provider based on volume. The new model will now require the provider to provide information on the quality of service being given, how valuable it is to the patient, and accountability that provider has to the treatment being performed. In order to measure these parts of service together, MACRA has a three part system put in place:

1. PQRS, Physician Quality Reporting System
2. VBM, Value Based System
3. EHR, Electronic Health Record

The Physicians Quality Reporting System (PQRS) aims at having individual and group practices that bill for Medicare under Part B, to report the quality of care they are giving their patients. Participation in reporting the data can take place in two ways:

Exceptions

• If this is your first year participating in the Medicare program you are not able to participate in MIPS.

How does Participation in the Program Affect your Practice?

If your practice meets the guidelines for participation it can be affected in a few different ways beginning in 2018.

• If you choose not to participate at all:
  • Your practice will see a 4% decrease in reimbursement rates
• If you are in testing phase:
  • You may be able to avoid the 4% penalty with enough measurable data submitted but you will not receive any incentives
• Half Participation:
  • If you are partially participating in the program then you may be able to earn a small payment adjustment on claims.
• Full Participation:
  • If your practice has been submitting measurable data for a year then you are on the right track to receiving a payment adjustment on those claims for quality work reported.