The Final MACRA Rule: What Providers Need to Know

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You’ve likely started to implement MACRA in your practice, but what are the details of the final rule, and why did it come about? What does it specifically imply for your practice and how can you make sure your EHR software is up to par with new requirements? We’ve uncovered what you really need to know to successfully participate in the program and reap its benefits.

First a refresher: MACRA is the Medicare Access and CHIP Reauthorization Act, passed in April 2015 to end the Sustainable Growth Rate (SGR) formula and establish the Quality Payment Program. After the original legislation, Centers for Medicare and Medicaid (CMS) received feedback via over 4,000 comments raising concerns about the transition to MACRA, spurring changes in the way the law is rolled out. The resulting MACRA Final Rule came out in October 2016.

The Final Rule acknowledges the complexity of the law and allows for flexibility in the roll-out. It still includes the same two program tracks — the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (Advanced APMs) — but simplifies the ways in which performance measures within these two program tracks will have to be reported. The rule also offers a transition period for implementation: an opportunity to get MACRA-compliant practice management in line with simple ways to avoid compliance penalties.

In 2017, practices that select the MIPS track will have to report on one of the program’s four performance categories, provide data for only one Medicare patient, or submit just 90 days worth of data to comply. Practices that do submit the full set of data for the whole calendar year will be eligible for up to a 4% positive adjustment on Medicare reimbursements. For those that select the Advanced APM option, the models have been streamlined and the thresholds of eligibility have been lowered, so that more practices can qualify for this program track. If your practice qualifies for Advanced APMS, you can see up to a 5% bonus for your practice, and you don’t have to report based on the MIPS system.

The transition period is meant to help practices avoid having to pay penalties and to help ease providers into performance reporting according to the MACRA rules. By 2019, the program will require reporting according to the guidelines outlined by the original rule.

Because of the additional reporting involved, MACRA means that a patient record system that works well for your staff is more important than ever. On the MIPS track, the “Advancing Care Information” performance measures specifically speaks to the use of certified EHR technology to improve how data is exchanged between doctors and providers and reported to CMS. 1st Providers Choice offers specialty-specific EHR software tailored to patient conditions and provider needs. To get started implementing MACRA with an optimal EHR, contact us or call 480-782-1116.