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Phoenix Ortho

MACRA

The CMS Rule for Quality Payment Program reporting 2017 and beyond.

Overview

This will give you general information on the MACRA MIPS Rule for 2017.  The FINAL rule was published on October 14, 2016.  HOWEVER, there is still an open comment period that ends December 19th, 2016.  We will update our information as it is published to keep you informed.  We are waiting on the final FINAL rule to be published by CMS.

For more information, please refer to the CMS website:  MIPS Overview

Customers, see the live webinar training on the Proposed Rule:  Proposed Rule 2017 Overview*     

*You must be logged in to the Help Site as a customer to view the webinar.

Final Rule voted on October 14, 2016.  ONC Fact Sheet

For additional and specific measure information:  Quality Payment Program Information Site

Click Here for the Quality Payment Program Fact Sheet

CMS QPP Final Rule Webinar Slide Deck from November 15, 2016

What is MACRA?

MACRA stands for Medicare Access and CHIP Reauthorization Act of 2015.  This is a bipartisan legislation that replaced the flawed Sustainable Growth Rate formula with a new approach to paying clinicians for the value and quality of care they provide.

What is MIPS?

MIPS stands for  Merit-based Incentive Payment System.  Through this law, Congress streamlined and improved programs into one new program.  This is a replacement to the programs we know now as PQRS, Meaningful Use and Value Based Modifier.

Proposed Timeline

This is an aggressive timeline.  Reporting to start January 1, 2017 and the rule has not been finalized to date.

Proposed_MIPS_Timeline.png

How does MIPS work?

You earn a payment adjustment based on evidence-based and practice-specific quality data. You show you provided high quality, efficient care supported by technology by sending in information in the following categories.

Getting ready for MIPS

Should I participate in MIPS as an individual or a group?

Reporting as an individual.

If you send MIPS data in as an individual, your payment adjustment will be based on your performance. An individual is defined as a single National Provider Identifier (NPI) tied to a single Tax Identification Number.

You’ll send your individual data for each of the MIPS categories through an electronic health record, registry, or a qualified clinical data registry. You may also send in quality data through your routine Medicare claims process.

Reporting as a group.

If you send your MIPS data with a group, the group will get one payment adjustment based on the group’s performance. A group is defined as a set of clinicians (identified by their NPIs) sharing a common Tax Identification Number, no matter the specialty or practice site.

Your group will send in group-level data for each of the MIPS categories through the CMS web interface or an electronic health record, registry, or a qualified clinical data registry. To submit data through our CMS web interface, you must register as a group by June 30, 2017.

MIPS Overview

Use this tool to browse the different MIPS measures and activities.

Category What do you need to do?

Quality

Replaces the Physician Quality Reporting System (PQRS).

Most participants: Report up to 6 quality measures, including an outcome measure, for a minimum of 90 days.

Groups using the web interface: Report 15 quality measures for a full year.

Groups in APMs qualifying for special scoring under MIPS, such as Shared Savings Program Track 1 or the Oncology Care Model: Report quality measures through your APM. You do not need to do anything additional for MIPS quality.

Improvement Activities

New category.

Most participants: Attest that you completed up to 4 improvement activities for a minimum of 90 days.

Groups with fewer than 15 participants or if you are in a rural or health professional shortage area: Attest that you completed up to 2 activities for a minimum of 90 days.

Participants in certified patient-centered medical homes, comparable specialty practices, or an APM designated as a Medical Home Model: You will automatically earn full credit.

Participants in certain APMs under the APM scoring standard, such as Shared Savings Program Track 1 or the Oncology Care Model: You will automatically receive points based on the requirements of participating in the APM. For all current APMs under the APM scoring standard, this assigned score will be full credit. For all future APMs under the APM scoring standard, the assigned score will be at least half credit.

Advancing Care Information

Replaces the Medicare EHR Incentive Program, also known as Meaningful Use.

Fulfill the required measures for a minimum of 90 days:

 Security Risk Analysis

 e-Prescribing

 Provide Patient Access

 Send Summary of Care

 Request/Accept Summary of Care

Choose to submit up to 9 measures for a minimum of 90 days for additional credit.

For bonus credit, you can:

 Report Public Health and Clinical Data Registry Reporting measures

 Use certified EHR technology to complete certain improvement activities in the improvement activities performance category

OR

You may not need to submit advancing care information if these measures do not apply to you.

Cost

Replaces Value-Based Modifier.

No data submission required. Calculated from adjudicated claims.

Why should you participate?

There is a lot of flexibility with the MIPS program.  It is not like the "all or nothing" Meaningful Use is, it has options for you to pick what best fits your practice.

Scoring

This is the breakdown of the scoring for each performance catagory.  Reporting a minimum of 90 consecutive days for 2017 will keep you from getting a negative adjustment. The more you report, the better.

How will the Quality Payment Program change my Medicare payments?

Depending on the track of the Quality Payment Program you choose and the data you submit by March 31, 2018, your 2019 Medicare payments will be adjusted up, down, or not at all. The information provided below is only relevant for the 2019 payment year. CMS will provide additional information on payment adjustments for 2020 and beyond beginning next year.

 

Who can Participate?

Who is in the Quality Payment Program?

You are eligible to participate in the MIPS track of the Quality Payment Program if you bill more than $30,000 to Medicare, and provide care to more than 100 Medicare patients per year, and you are a:

Who is not required to participate?

If 2017 is your first year participating in Medicare, then you are not required to participate in the Quality Payment Program in 2017.