MACRA & MIPS




MACRA & MIPS

The Medicare Meaningful Use program as we knew it ended in 2016, however it has been rebranded into the new performance based incentive program from CMS called Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). The act was passed by the bipartisan Congress and signed into law by President Obama in April 2015.
MACRA introduces the Quality Payment Program which emphasizes value-based models like MIPS and APMs.

On October 14, 2016, the Department of Health and Human Services (HHS) issued the Final Rule on MACRA.

  • CMS made some significant changes in the proposed rule and offers more flexibility and pick-your-own-pace approach.
  • Reduced the number of required measures.
  • Reduced the time and cost for small practices*. Excluding more small practices from the program. Simplified reporting and scoring.
  • Complete patient and provider confidentiality.
  • Introduced the new Quality Payment Program website which explains the new program and helps clinicians identify the measures and activities that are most meaningful to their practice or specialty: qpp.cms.gov

The Merit-Based Incentive Payment System (MIPS) streamlines Medicare Meaningful Use, PQRS and Value-based Payment Modifier into one program.
MIPS will annually measure Medicare Part B providers in four performance categories to derive a score ranging zero to one-hundred, which can significantly change a provider's Medicare reimbursement in each payment year.

The performance categories under MIPS are:

  • Advancing Care Information (formerly Meaningful Use)
  • Quality (PQRS/VBM)
  • Clinical Practice Improvement Activities (New category)
  • Resource Use

In 2018, your performance depends on four categories:

  • Quality which accounts for 50%
  • Advancing Care Information which accounts for 25%
  • Improvement Activities which accounts for 15%
  • Cost which accounts for 10%

Reporting Period and Deadline:

A minimum of 90-day continuous period is required. However, for Quality a 12-month performance period is required. You can start any time between Jan 1st and Oct 2nd 2018. The deadline for data submission is: March 31st, 2019.