Meaningful Use made adding EHR to practices more affordable for hundreds of thousands of independent doctors. Quite a bit has changed since 2015. MACRA’s main objective is to enhance Medicare beneficiaries’ treatment. The payment system under MIPS medicare switches from volume to value and results.
The Ziaccu software complies with and fulfills all MACRA-related standards as an ONC 2015 Certified EHR. The Quality Payment Program (QPP), a new value-based compensation system introduced by MACRA (Medicare Access and CHIP Reauthorization Act of 2015), has three significant modifications that may affect your Medicare payments.
A new paradigm for paying doctors for delivering higher-quality treatment was created by MIPS medicare. The QPP’s two tracks are:
- Alternative Payment Models for the Merit-based Incentive Payment System
- Medicare’s sustainable growth rate (SGR) algorithm, which determined physician payment reductions, was eliminated
Three separate reporting programs’ components are integrated into one system:
- Value-Based Payment Modifier
- Physician Quality Reporting System
- Meaningful Use in Medicare
What are MACRA and MIPS Medicare?
The 2015 MACRA law implemented the MIPS Medicare reimbursement system, and your practice may be required to register and provide data. The federal statute known as MACRA is the one that made MIPS mandatory. If your practice meets specific requirements, you can be compelled to provide MIPS data. Better treatment can result in higher payouts from the MIPS program for your practice, just as poorer care might result in lower reimbursements.
Your physician type, billing volume, and other considerations will determine if you qualify. Some qualifying practitioners are not compelled to participate, while others must participate. Medical professionals are interested in learning if the individual or group care they offer qualifies them for MIPS.
Consider the last time you worked at your medical office in peace. If you can’t think of any, you’re probably using the typical fee-for-service business model, forcing you to see as many clients as possible to make a profit. This paradigm hasn’t exactly won over many physicians’ hearts, and neither have politicians. Because of this, in 2015, the federal government passed a law known as MACRA, resulting in MIPS reporting, which moves certain practitioners away from the fee-for-service paradigm.
Understanding the concept of MIPS
Medicare’s payment to your clinic for its services is based on MIPS reporting. It provides a composite performance score for your practice that impacts how much Medicare will pay you. Four variables will determine your score, ranging from 0 to 100: quality, interoperability promotion, improvement efforts, and cost.
The criteria that CMS and professional medical associations have established form the foundation for the quality of treatment you offer. You select the six quality measures that are most appropriate for your practice, and CMS will only assess you using those criteria. Quality will account for 30% of your MIPS score in 2022.
To facilitate the electronic interchange of health data and enhance patient participation, this category encourages practices to employ certified EMR software. Your PI score will account for 25% of your overall MIPS score in 2022.
The actions you take to improve your patient care procedures are reflected in your improvement activities score. Additionally, it monitors how you might increase access and patient participation in your treatment. You may select the improvement measures that make sense for your practice, just like with the quality metric. Improvement activities will contribute 15% of your score in 2022.
For providers, what do MACRA and MIPS mean?
Since MIPS is budget-neutral, financial incentives are distributed according to a sliding scale. To offer incentive payments to providers based on their performance in the four MIPS categories, CMS uses the money it saves from providers that get payment reductions. Three times as much can be moved in the positive direction as in the opposite direction.
Since the QPP is budget-neutral, the quantity of providers that share the $500 million MACRA allotted for this purpose determines the number of incentive payments received in a particular payment year. MACRA and MIPS impact the following practice and practitioner considerations.
- Your reimbursement amounts: If your MIPS score is 75 or above, you will be reimbursed 27% more than you normally would. On the other hand, reimbursements are 9% less if your MIPS score falls below 75. Your reimbursement amount remains unchanged if your MIPS score is exactly 75.
- How you employ medical software: The government is pressuring medical practitioners to convert from paper records to digital ones utilizing medical software, as seen by the PI component of the MIPS program score. According to CMS, almost 9 out of 10 providers presently utilize an EMR system, signaling that this shift is almost complete across all providers.
- A change in care models for the whole medical sector: A fee-for-service model and value-based care are extremely distinct from one another, and MACRA and MIPS may cause the former to eventually eclipse the latter. This would imply that physicians no longer need to maximize their appointments in order to increase their income. An industry with fewer overworked doctors attempting to accomplish too much might be the outcome.
MACRA Healthcare Reform Quick Reference
- Removed the Sustainable Growth Rate technique from calculating the yearly conversion factors for medical services.
- Rolled out a new methodology that emphasized alternative payment options to compensate professionals for value over volume
- Physician Quality Reporting System (PQRS), Value-Based Payment Modifier (Value Modifier), and Medicare EHR Incentive Program (also known as Meaningful Use or MU) were requested to be phased out and are now simplified in the new Merit-Based Incentive Payments System (MIPS)
- Bonuses provided for taking part in Advanced Alternative Payment Models that are appropriate (APMs)
Conclusion
Any additional expenses an EP, EH, or CAH would incur to adopt the features of the Complete EHR or Health IT Module in an effort to achieve the goals and metrics for meaningful Use. Developers must also mention any significant contractual or technological restrictions on their products.
Except for a one-time short set-up for the deployment of e-prescribing of restricted drugs, all tested and certified modules described above are included in the monthly subscription charge for Ziaccu . These services consist of private CMS Incentive Program coaching and the creation of customized templates.