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MACRA / MIPS

MACRA and MIPS Success Made Easy With MediTouch

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) officially began on January 1, 2017. Otherwise known as the Quality Payment Program, MACRA replaces the Fee-for-Service (FFS) payment model and Sustainable Growth Rate (SGR) formula. MACRA applies to all clinicians who receive Medicare Part B payments, with few exceptions.

MACRA’s Paths: MIPS and AMPs

macra ehr software pathsThe scoring method is complex, but simply put: MIPS providers will be scored in four separate performance categories (Which are each weighted differently), and the sum of these scores will amount to a total, aggregated “composite” score.

old MACRA MIPS programsMIPS

The following programs as we know them have ended, have been repackaged, and rolled into MACRA/MIPS:
• Meaningful Use
• Value-Based Modifier
• Physician Quality Reporting System

MIPS Performance Categories

macra ehr mips performance catagories

The four performance categories that will make up MIPS participants’ total score are as follows:
Quality: 60%
Advancing Care Information: 25%
Clinical Practice Improvement: 15%
Resource Use/Cost: 0% (No reporting is required for this. It’s calculated from adjudicated claims.)

Remember: Unlike old programs (such as PQRS), which worked similarly to a “pass/fail” grading system, MIPS providers are “graded” on a curve.

macra ehr software performance

macra ehr software pass fail

These Providers are Excluded from MIPS

• Providers in their first year of Medicare Part B
• Providers with fewer than 100 Medicare patients per year OR less than or equal to $30,000 in Medicare bill charges per year
• Providers participating in certain APMs

macra sample population

Flexibility: For the first reporting period 2017

CMS has declared 2017 as a transition year for MACRA. Providers who qualify for MIPS can “pick their pace.” MediTouch software will allow each provider to choose their reporting period for the year.

Full year: Prepared? Report a full calendar year of data; possible full bonus.
Partial year: Somewhat prepared? Report all requirements for less than a year; possible smaller bonus
Report anything: Not prepared? Report any data for less than a year; no penalty, no bonus.

* Report nothing in the first year of MACRA will receive a -4% penalty.

How Will the Payment Adjustments Work?

In the first year of MACRA, 2017: A provider who chooses to report for the full calendar year has the *potential to earn up to 4% positive payment adjustment, depending on how high above the bell curve he or she lands. Those providers who perform as “A” students on the curve “could” receive a “modest” payment adjustment. The very few who perform as Valedictorians have the potential to receive up to a 12% positive payment adjustment in the first year. Payment adjustments increase with each year until 2020 and beyond.

payment-schedule

How Can MediTouch Help You?

  • Easily accessible dashboards for physician performance
  • Automated quick actions to improve score of entire population
  • Easy comparison of provider performance across practice
  • Detailed views and patient summaries for quick action to improve scores
  • Track performance on selected measures and report on top CQM
  • Automated reporting for easy submissions to CMS
  • Detailed training modules and customer support on all aspects of MACRA