Making Sense of MACRA in 2018: Six Things You Need to Know
The rules for complying with Medicare's Quality Payment Program are getting stricter.
Fam Pract Manag. 2018 Jan-Feb;25(1):21-24.
Author disclosure: no relevant financial affiliations disclosed.
The Quality Payment Program (QPP), which resulted from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is designed to reward or penalize physicians based on the quality of patient care they provide. Last year, physicians could “Pick Your Pace” through an introductory program that allowed physicians to test the waters. But in 2018 physicians will have to more fully engage with the program or risk a negative payment adjustment of up to 5 percent in 2020. Successful participation could earn a positive payment adjustment of 5 percent or more in 2020.
QPP will be updated annually through the federal rulemaking process. The 2018 rules, released on Nov. 2, made significant changes in six key areas. Physicians participating in the Merit-based Incentive Payment System (MIPS) track of QPP will need to focus on these changes to succeed during the 2018 performance period.
Physicians' performance in 2018 will affect their Medicare payments in 2020.
The required reporting period for some MIPS categories has increased to a full year, and physicians must provide data for a larger percentage of patients.
The Centers for Medicare & Medicaid Services has raised the low-volume threshold under the Quality Payment Program to exempt more small practices and solo physicians from the Merit-based Incentive Payment System (MIPS).
Physicians and small group practices can now join “virtual groups” to amass their data and better participate in MIPS.
A physician's cost of care now accounts for 10 percent of his or her MIPS final score.
Physicians who belong to small practices or who provide high-complexity patient care are eligible for bonus points.
1. THE LOW-VOLUME THRESHOLD RISES
In 2017, the Centers for Medicare & Medicaid Services (CMS) set limits below which physicians were exempted from having to participate in MIPS. Those limits exempted physicians who provided care to 100 or fewer Medicare Part B beneficiaries or who received $30,000 or less in Medicare Part B payments.
This year, CMS is raising the low-volume threshold to exempt more small practices and solo physicians from MIPS. Physicians who care for 200 or fewer Medicare Part B beneficiaries or receive $90,000 or less in Medicare Part B payments are exempted.
To check your eligibility, use the CMS look-up tool.
2. VIRTUAL GROUPS BECOME REALITY
Virtual groups — composed of individual physicians
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