How will MACRA effect your revenue?
The Medicare Access and CHIP Re-authorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, which threatened clinicians participating in Medicare with potential payment cliffs for 13 years. If you participate in Medicare Part B, your future revenue will be penalized or increased by the new Quality Payment Program (QPP). Practices can participate in two tracks: Advanced Alternative Payment Models (APMs) to earn an incentive payment for participating in an innovative payment model or The Merit-based Incentive Payment System (MIPS) earning a performance-based payment adjustment.
Who will be effected?
Practices will be effected by QPP in 2017 if they are in an APM or if they bill Medicare more than $30,000 a year and provide care for more than 100 Medicare patients a year. To participate in MIPS you must also be a Physician, Physician assistant, Nurse practitioner, Clinical nurse specialist, or Certified registered nurse anesthetist.
Positive and Negative Adjustments
Most practices will fall under the MIPS category. There will be a positive OR negative 4% adjustment to all clinicians in 2019 Medicare payments based on reporting for 2017. Based on “Budget Neutrality”, the incentive payment could be up to 3 times the adjustment if only a small amount of participating clinicians’ Composite Performance Score (CPS) meets the published benchmark.
Pick your path
Practices will have the following options available to them in 2017
- Do not report MIPS – 4% will be deducted from your Medicare payments in 2019
- Test with MIPS – Only report 1 component of the CPS and you will not received a negative adjustment in 2019
- Partial Participation– Report multiple components of the CPS for at least 90 days and you could received a positive adjustment in 2019
- Full Participation– Maximize your CPS for 91 days which may lead to a 12% positive adjustment to Medicare payments in 2019. The reporting period must begin by October 2, 2017.
There are shared savings and risks involved with APMs. We recommend viewing webinars offered by the Center for Medicare and Medicaid Services (CMS) found at the below site for more information.
Information from this blog derived from the Quality Payment Program Service Center at www.qpp.cms.gov.
Medical A/R Revenue Solutions, LLC can help your practice understand MACRA and accomplish your revenue goals. Call us today at (850) 219-0011 or email jamesb@armedicalclaims.com to schedule your free consultation!