A stethoscope and American money on a white background - HealthcEven without potential changes to the Medicare program, MACRA poses a significant challenge for any clinician trying to determine the best strategy to maximize Medicare reimbursement – there are hundreds of pages of guidance in the proposed and final regulations to review and understand. But, at this point, clinicians attempting to assess MACRA must also deal with uncertainty about changes to the Medicare program. A significant source of uncertainty is the Trump administration’s stated intent to repeal the Affordable Care Act (“ACA” and also known as Obamacare), which is being implemented by current legislative efforts. Uncertainty about the ACA should be considered in developing a strategy to comply with MACRA. Continue Reading Managing MACRA – Part VII: What happens to MACRA if the Affordable Care Act is repealed?

A stethoscope and American money on a white background - HealthcUnder MACRA, the merit-based incentive payment system (MIPS) automatically applies to eligible clinicians (generally a physician or mid-level – see our previous blog post for details) and most clinicians who treat Medicare patients are expected to be included in MIPS. As a result, one of the most common questions about MACRA is when it starts. CMS’s final MACRA rule confirms that implementation begins Jan. 1, 2017. Continue Reading Managing MACRA – Part IV: When does it begin?

A stethoscope and American money on a white background - HealthcUnder MACRA, the merit-based incentive payment system (MIPS) automatically applies to an eligible clinician (generally a physician or mid-level – see our previous blog post for details) except in certain circumstances. One of the circumstances in which an eligible clinician is excluded from MIPS is when the clinician participates in an advanced alternative payment model (APM) that meets certain operational, risk and patient/payment volume requirements. Notably, a participant in a qualifying advanced APM receives a 5 percent annual bonus payment from 2019-2024. A participant in an advanced APM who does not meet the patient/payment threshold requirements may still be exempt from MIPS adjustments (although such a partial qualifying advanced APM participant may choose to participate in MIPS) but will not receive the advanced APM bonus. Continue Reading Managing MACRA – Part III: What is an APM?

dollar-signiStock_000013001848_LargeOn April 27, 2016, the Department of Health & Human Services Centers for Medicare & Medicaid Services (CMS) released its proposed rule regarding models for tying professional reimbursement to quality. While this may be great news for providers who enjoy the challenges of tracking and reporting data, these challenges are going to cause problems (namely, reimbursement reductions) for some providers. Regardless of whether providers think this is good or bad, providers should start looking at the proposed regulations now because, as proposed, quality-based payments will be a fact of life for all physicians, mid-levels, CRNAs and groups effective Jan. 1, 2019. The regulations will be published in the May 9, 2016, Federal Register. The comment period will officially start at that time and run through 5 p.m. on June 27, 2016. Continue Reading CMS’ quest for quality – proposed merit-based and alternative payment model rules released