There’s some good news on the horizon concerning MACRA rules replacing Meaningful Use and PQRS programs as they affect smaller practices.
Earlier projections from CMS using data from its previous 2014 reports predicted that as many as 87 percent of solo practices could face a negative adjustment equaling a total loss of $300 million in the first year of MACRA. For practices with 2-9 clinicians, the numbers weren’t much better.
Following an impact analysis in response to concerns that MACRA’s proposed final rule would negatively affect small and rural practices, CMS built in more flexibility to better accommodate practices with 15 or fewer clinicians as well as those in rural and under-served areas:
Two track reporting options offer more choices
MACRA’s two tracks for provider reporting, referred to as the Quality Payment Program, include the Merit –based Incentive Payment System (MIPS) and the Alternative Payment Modules (APM) track.
2017 saw the initial MIPS reporting, which adjusted for payment in the four categories below. CMS measured clinicians’ performances for 2019 payment adjustments, for either positive or negative adjustments of up to 4 percent in 2019, as well as determining which meet the APM requirements. Evaluations were based on:
- Clinical improvement
- Advancing care information
MIPS-track providers can choose to either submit a minimum amount of information (such as individual quality performance), data covering a 90-day or longer period with more than one quality measure activity or data covering a full year.
Increased exemption criteria benefits smaller practices
While almost all practices will start with reporting through MIPS, those practices having the following criteria were considered exempt from reporting requirements for 2017:
- $30,000 or less in annual Medicare Part B charges
- Serve at or below 100 Medicare patients, or
- Will be in their first year of participation in Medicare.
APMs as payment models and other flexible options include Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs). Practices choosing this track be awarded lump-sum payments from 2019-2024 - a bonus equal to 5 percent of Medicare reimbursements and exemption from MIPS reporting requirements.
Additional special rules apply for smaller practices as well as rural and healthcare provider shortage areas.
- Practices using any of the three reporting choices can avoid penalties in 2019, while non-participating practices will lose 4 percent from their Medicare reimbursements.
- Increased flexibility in reporting options compared to earlier versions should enable smaller practices to participate in the quality payment program at rates close to larger organizations. As a result, CMS is predicting about 90 percent of MIPS-eligible clinicians, with 80 percent in small or solo practices, will see either no change in reimbursement rates or will receive a bonus.
- According to CMS acting administrator Andy Slavitt, a new website has been created to help providers better understand and participate in the program.Additionally, funds will be available for rural and smaller practices for technical assistance, including learning and reporting data as part of a Health Care Payment Learning and Action Network.
Can a medical billing and practice management service help a smaller practice?
Many smaller practices don’t have the financial or staffing resources to invest in the latest EHR technology updates to keep up with rapidly-changing rules and regulations, whether from CMS or third-party payers. By outsourcing billing and other claims-related tasks to a qualified, experienced third-party, practices can save time and money to be reinvested into meeting the practice’s other needs.
M-Scribe’s experienced claims personnel use the latest technologies as well as are current on MACRA and other rulings from CMS and other payers. Contact us either email firstname.lastname@example.org or at 770-666-0470 for a free consultation to learn how an analysis of how your practice can benefit from faster, more accurate claims turnaround and improved reimbursements.