An important role of the healthcare institutions is to provide quality health services to a diverse population. Besides, they also take care of the patient satisfaction, operating costs, medical outcomes, the requirements of the government mandates and regulatory compliances.
A big transformation in the medical sector came with the passing of MACRA or Medicare Access and Chip Reauthorization Act. It is a rather complex piece of legislation, but a beneficial one that will bring a new dawn in the clinical payment in the coming decades.
Understanding the basics of MACRA
MACRA is an outcome of CMS and HHS coming together to end the degraded practise of the Sustainable Growth Rate, to oversee any discrepancy in payments. MACRA holds within its jurisdiction the payment of the physicians based on the quality of the service by the largest healthcare insurer of the United States, CMS. Though the process will start from the 1st January, 2017, the reimbursement to the doctors will be from 2019.
But, if you think that 2019 is far away, think again! 2017 will be a crucial year for the medical billing sector as it will have a direct impact on the payment computation. Here, let us understand how will MACRA influence your practise in 2017. To put it in a very simple term, MACRA means paying the medical practitioners based on their quality service and the outcome, rather than on the volume. Under MACRA legislation, there are two modes of payments- The Merit Based Payment System (MIPS) and Alternative Payment Models (APM).
Impact of MACRA on your practise in 2017
The year 2017 will be very crucial for the medical practitioners as it will set the base for reimbursement adjustments in 2019. The basic and notable upgrade of MACRA’s Quality Payment Program (QPP) is the transition from fee based on service to fee based on value. Due to this, the most visible impact will be a drastic change in clinical performances in 2017. The medical industry will witness the following impact in 2017.
MIPS and APM will be the two options for Medicare Provider Payment
MIPS is a combination of the PQRS, Value Modifier and EHR. Under MIPS, the eligible professionals like doctors, nurses, chiropractors, dieticians and all the professionals related to the medical industry will be measured on the following factors-
- Proper use of certified EHR technology
- Clinical practise improvement and
- Proper resource use
The participants of the APM will receive a few beneficiaries. They will automatically reap the benefits of MIPS and additionally get anual 5% bonus payments from 2019-2024, will be entitled to more flexibility through physician focused payment models.
An increase in provider reimbursement
From 2019 to 2026, the rate for APM and MIPS will remain static, which will witness a rise annually from 2026. From 2026, the MIPS will increase by 0.25%, which is a downfall from the regular 0.50% annually. But, as far as APM is concerned, the annual payments will increase by 0.75%. All these have triggered a very crucial concern that it will become rather difficult, with such annual payment rates to keep up the pace with inflation.
Penalties will come in
High performing physicians will be entitled to bonuses, whereas the low performing ones will have to face penalties. If the MIPS scores goes down continuously for a physician, then the penalties will be 4 %, 5%, 7% in 2019, 2020 and 2021 respectively.
A direct impact on the physician practise FMV
Due to MACRA and the creation of two Medicare payment provider models, there will be a fair impact on the future physician practices. Physicians will now focus more on value based practice as the reimbursement will get shifted towards value based payments.
Therefore, MACRA will benefit the medical industry owing to the fact that it will put an end to the sustainable Growth Rate and improve the quality of the medical service. To all the low performing and corrupt practitioners, MACRA may seem a nightmare as it will impose penalties.
So, what you need to remember in 2017 is to improve the patient care service and take proper measures to implement financial strategies so that you can get proper reimbursement in 2019.