Moving Forward With MACRA
How are small and mid-sized organizations supposed to keep up with all the new requirements of the MACRA legislation with the tedium of detail and legal jargon contained in the more than 2,000 pages of the final release?
If your organization is like most, the ability to flesh out all the requirements is difficult. To complicate the situation, reporting started January 1, 2017. That leaves little or no time with constrained resources for you to tackle MACRA. Below are three critical points that will help you in navigating the process.
2017 MACRA Strategy and Beyond
- COMPLETE COST-BENEFIT ANALYSIS. Determine the financial impact MACRA could have on your organization. Remember reporting year 2020 includes a 9% penalty for failure to report, with the adjustment for year 2020 happening in 2022.
- PICK YOUR PACE. CMS has initiated “Pick your Pace” to help organizations acclimate to the new program.
- DON’T REPORT
- Don’t report any data in 2017
- Receive a 4% penalty in 2019 for all allowable MPFS payments
- KIND OF REPORT
- Report on one measure in the quality component
- Report on one clinical practice improvement activity, or
- Report on the required measures for advancing care
- This may earn you a neutral or positive payment adjustment
- PARTIAL REPORT
- Report performance for a minimum of 90 continuous days in 2017
- Report on more than one measure in the quality component
- Report on more than one clinical practice improvement activity, or
- Report on more than the required measure for advancing care information for a 90 continuous days
- This qualifies you for up to a 12% bonus on all 2019 MPFS payments
- FULL REPORT
- Report results on all required measures for a minimum of 90 continuous days in 2017
- This qualifies you for a 12% bonus on all MPFS payments as well as eligible a 10% exceptional performance bonus
- DON’T REPORT
Focus on MIPS
Most providers will be required to report under the Merit-based Incentive Payment System (MIPS) requirements for the 2017 reporting period. If your organization has not made progress on the MACRA legislation. Focus on MIPS first.
Identify the measures under the three categories; cost, advancing care information, and improvement activities in which your organization could potentially participate.
- Are you already tracking some of the measures?
- What measures could you adjust your workflows to track?
If you have previously reported under PQRS and Meaningful Use leverage that work to enable efficient reporting under MIPS.
Low Volume Threshold
Understand that if you are a low volume Medicare clinician you may have the option to not report at all. Physicians that bill less than $30,000 in allowed Medicare charges or see fewer than 100 Medicare patients per year are not required to report MIPS. If you decide to report as a group, this might put you over the low-volume threshold.
The Balance
With MACRA comes more processes to account for and maintain. Providers forced to redirect resources toward creating and enforcing quality measures to prevent future losses, will struggle to balance their focus in the business office. Payers may adopt a value-based reimbursement model, most likely with different rules than Medicare. With this shift, payers are looking to collaborate with others to support key revenue cycle areas. Collaborating with a company that has great technology and efficient processes in areas such as patient access, coding, and billing, will allow facilities to focus on value-based efforts, seeing a potential increase to their bottom line by doing so.
About the Authors
Brandon Hayes
REVENUE CYCLE SENIOR DIRECTOR FOR HEALTHCARE RESOURCE GROUP, INC.
Brandon Hayes’ superior customer service skills paired with his passion for helping others naturally drew him to the healthcare industry. Brandon, originally an Environmental Water Science graduate, took to revenue cycle management like a fish to water. He quickly went from an early out self-pay customer service team member to the Revenue Cycle Senior Director for HRG, the same company he started his healthcare career with 7 years earlier.
Brandon works actively with his division to exceed industry customer service standards, provide ultimate client results, and proactively adapt to all industry and patient communication regulation changes.
Brant Truman
BUSINESS ANALYST FOR HEALTHCARE RESOURCE GROUP, INC.
Brant Truman, graduate student of Health Policy and Administration at Washington State University, is passionate about the healthcare revenue cycle and educating others on industry updates within the field. He is knowledgeable on policy changes and the implications they have on provider reimbursements.