10 Fast Facts About MACRA You Need To Know


1. MACRA, the Medicare Access and Chip Reauthorization Act, is the law that created MIPS — the Merit Based Incentive Payment System. MIPS replaces 3 previous CMS programs: PQRS, VBM, and Meaningful Use. While it may combine the programs into one single program – there are many new requirements, making the ruling complicated.

2. MIPS was created to provide direction for healthcare systems and providers to shift completely to a value based care model.

3. MIPS focuses on what CMS views as critical for success in a value based care model: improved overall quality of care, leveraging data and technology to increase care coordination and improve outcomes, and lower overall costs by focusing on wellness and disease prevention.

4. MIPS begins on January 1st and compliance is required all year. Organizations must plan ahead to ensure full and complete compliance.

5. Health eFilings is a data submission vendor. Data submission vendors will be the only vendors who can help you fully comply with all of MIPS.

6. Using Health eFilings MIPS Accelerator has significant and automatic advantages: your quality score will be raised by one decile, and 4 out of 6 of the required CPIA activities will be satisfied.

7. Almost all providers who reported for the 2016 Reporting Period will need to report in 2017. However, there are some exceptions. For more details about MIPS eligible providers, click here.

8. Scoring for MIPS is extremely complicated. It is broken into 4 categories: Quality (60% of your score); Advancing Care Information (25% of your score); Clinical Practice Improvement Activities (15 % of your score), Resource Use (0% of your score, but still collected). Maximizing your score means putting an increased emphasis on bench marking against your peers, identifying and selecting high priority measures, and eliminating measures that top out if too many reach 100%.

9. For the 2017 submission year – MIPS penalties can reach 4% and MIPS incentives are up to 12%. While outwardly, it may appear that the penalties are lower and one could simply just forgo the incentives by not complying – the shift to value based care has also changed the way that providers are reimbursed. Under the older volume-based care model, providers were paid from the outset for the number of visits and services provided regardless of outcome or overall quality. The new value-based-care model puts the focus on outcomes and quality, and reimbursements are adjusted accordingly. Maximizing your reimbursements means you must benchmark in the top 25% of your peers.

10. MIPS scores will be publicly available on Medicare’s Physician Compare website. Patients and potential patients will have full access to how your healthcare system or providers scored relative to their peers.