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 Download BrochureWhat’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
Sustainable Growth Rate
Shifts from Volume to Quality
Shift from fee-for-service
to pay-for-quality
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.
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 2021 as the 5th performance year. Payment adjustments received in 2021 are based on 2019 performance.
MIPS Year 5 Program Overview
The new quality program structure increases emphasis on interoperability and quality, while decreasing patient costs.
|
|
Quality = 40% |
|
|
Cost = 20% |
|
|
Promoting
|
|
|
Improvement
|
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.
