MACRA (Medicare Access & CHIP Reauthorization Act)

MACRA
(Medicare Access & CHIP Reauthorization Act)

In November 2015, The Centers for Medicare & Medicaid Services (CMS) released the final rule for MACRA, altering how Medicare reimburses clinicians and their practices. It emphasizes quality, value, and clinicians taking more financial risk.

TSI Healthcare® is here to help you navigate through the murky waters of federal regulations.

Be sure to check out our other resources:

Download our MIPS 2021 Guide

What’s The Big Idea?

With a stronger emphasis on quality, value, and bigger financial risk, there are three key areas MACRA seeks to address.

Repeals SGR

Repeals SGR

Sustainable Growth Rate

Volume to Quality

Shifts from Volume to Quality

Shift from fee-for-service
to pay-for-quality

Extends CHIP

Extends CHIP

Children’s Health
Insurance Program

Congratulations to TSI Healthcare Small Practices!

In 2019, 100% of clients using our Quality Program Services received the exceptional performer bonus.

MIPS penalties/incentives are calculated based on a 2-year look-back period

Quality Payment Program

MACRA’s Quality Payment Program allows providers to choose between two participation tracks: MIPS or APMs.

 Download 2021 MIPS Guide

MIPS

APMs

Merit-Based Incentive Payment System

  • Combines Meaningful Use, PQRS/CQMs & Value-Based Modifier (VBM)
  • Measures providers on:
    • Quality
    • Promoting Interoperability (Formerly ACI)(Use of EHR)
    • Improvement Activities
    • Cost
  • Financial Implications
    • Can receive a negative or positive payment adjustment based on MIPS Composite Score
    • Can receive up to 9% max penalty for not meeting 2021 MIPS requirements

Alternative Payment Models

  • Measures providers on:
    • APM specific goals, similar to MIPS with a few additions & exceptions
  • Financial Implications:
    • APMs can receive incentive payments for providing high-quality & cost-efficient care
    • Advanced APMs bear financial risk & can earn a 5% bonus

Timeline

MIPS will continue in 2019 as the third performance year with payment adjustments beginning in 2021.

MIPS Year 5 Program Overview

The new quality program structure increases emphasis on interoperability and quality, while decreasing patient costs.

MIPS 2021 Pie Chart

Quality = 40%

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Cost = 20%

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Promoting
Interoperability = 25%

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Improvement
Activities = 15%

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Introducing Quality Program Services

Overwhelmed by MACRA and MIPS? Stress no more!
TSI Healthcare’s revolutionary new approach to federal policy assistance provides you with the next level of
regulatory assistance and client advocacy.

QP Central

An online resource center to help practices navigate the new MIPS requirements.

Workflow Workshops

Workflow “how-to” videos for easy learning on the fly for role-specific and specialty-specific measures.

Guided Assistance

Guided assistance with hands-on regulatory training from a Quality Program Specialist allows you to focus on patient care.

  • “There are a lot of changes coming with the new MIPS and MACRA programs for Medicare, and there is no way I could possibly stay on top of it and run a medical practice. We rely very heavily on the Government Regulations team at TSI Healthcare. Our practice greatly benefits from their knowledge about MACRA. They stay on top of the changes and help us navigate them.”

    Connie, Director of Business OperationsCape Fear Arthritis Care
  • "TSI Healthcare’s rheumatology specific EHR is very manageable to use, and their reporting system is very flexible. We are on track for meaningful use, and it has allowed us to enjoy a significant increase in revenue. This has let us add to staff and incorporate an ultrasound machine.”

    Kevin Hicks, MDCollaborative Arthritis Care, Inc.
  • "As government regulations continue to evolve, TSI Healthcare remains current regarding the changes and always keeps us informed in a prompt manner."

    Ana, Director of Clinical PracticeArthritis & Rheumatism Associates, M.D.
  • "TSI Healthcare is top-notch when it comes to federal policy guidance. They help us with attestation and they explain the government regulations."

    Hope, System Support & Implementation MangerTidewater Physicians Multispecialty Group, P.C.