There’s good news on the horizon for Medicare providers. Providers who qualify for Medicare Access and CHIP Reauthorization Act (MACRA) may have the opportunity to receive an incentive in the form of greater Medicare reimbursements if they are able to demonstrate high-quality care for patients. Practices...can recognize thousands of dollars in increased revenue.
The program’s payment increases are balanced by reduced reimbursements to providers who exhibit lower quality scores than their peers. Practices that plan ahead and keep an informed eye on key performance metrics throughout the year can recognize thousands of dollars in increased revenue.
Providers that successfully participated in recent Meaningful Use incentive programs are already likely well on their way to navigating MACRA’s Merit-Based Incentive Payment System (MIPS), as effectively using certified electronic health record systems (EHR) are a vital and shared component of both programs.
However, as with any new system – especially one that aims for as significant a transformation as MACRA is attempting – MIPS features a learning curve and some possibly difficult terrain to cross, if one hopes to achieve a positive, rather than a negative, reimbursement affect.
Regardless of the challenges, though, qualifying providers are already “on the hook” for 2017’s performance, in the form of adjustments in 2019 to their Medicare Part B reimbursements in the range of +4 percent to -4 percent.
Nevertheless, MIPS still has great potential to help many providers improve reimbursement values. In practice, it will take cost-effective quality tracking and a firm handle on an ever-evolving set of provisions to actually come out ahead – both of which are much more accessible to independent practices than meets the eye.
With quality measures making up the bulk of the overall scoring, the program features a host of them. Individual practices will need to choose six and those will vary according to the method of submission. Furthermore, quality measures each have their own criteria for data collection; knowing what must be documented in each visit to support a measure is critical. For highly specialized practices, identifying those six quality measures and figuring out the optimal way to track and monitor them over time can be quite challenging.
Consequently, tracking quality measure will require additional investment and effort on the part of physicians and practice administrators, many of whom are already dealing with staffing challenges. Achieving these valuable incentive goals without significantly increasing operational expenses may be a tall order for some providers.
Given the complexities of MACRA/MIPS, many effective practices will wisely decide not to tackle this transformation alone. Such practices will seek out qualified experts who can supply the education and guidance needed to successfully navigate MIPS’ complexities. Specialist practitioners are generally bogged down as it is, and most likely lack the time, resources and familiarity needed to circumvent penalties such as reduced reimbursements. But with the assistance of an expert who is steeped in MACRA/MIPS, adjusting to the new reimbursement mechanism could be much less arduous and, actually, financially rewarding.
Taken a step further, independent practices also have the option of implementing proactive service programs that monitor their MIPS performance throughout the year and intuitive dashboards that display their progress to identify areas for targeted and efficient improvements.
By having the ability to act, rather than react, practices that take advantage of such programs will be able to preempt penalties and even increase reimbursements despite MACRA’s newness and complexity.
MIPS|assist™ helps practices successfully navigate MIPS’ complex and constantly-evolving requirements and has been modeled on other unique AllMeds support programs, including MUcare and PQRS|assist. MIPS|assist provides MIPS-specific training, consultation, monitoring and submissions assistance and has already helped thousands of providers achieve valuable incentive goals and avoid costly penalties
To learn more about AllMeds MIPS|assist, click here.
MIPS will score a provider’s care by four components. Each of these will contribute a different percentage of the overall MIPS score in 2018, with the primary contributors being: