10 questions about MACRA everybody
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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.

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10 questions about MACRA

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10 questions about macra

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)


10 questions about macra

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.


10 questions about macra

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.


10 questions about macra

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


10 questions about macra

 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)


10 questions about macra

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


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