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6 things doctors need to know about MACRA final rule


The Centers for Medicare & Medicaid Services (CMS) released its final rule for the Medicare Access and CHIP Reauthorization Act (MACRA) October 14. Here’s what physicians need to know.




The Centers for Medicare & Medicaid Services (CMS) released its final rule for the Medicare Access and CHIP Reauthorization Act (MACRA) on October 14. Here’s what physicians need to know...




6. Who has to participate in MACRA? If you bill Medicare more than $30,000 annually or provide care for more than 100 Medicare patients each year, you are affected by MACRA. If you do not meet those benchmarks, you are exempt from its requirements.






5. When does MACRA take effect? The program begins Jan. 1, 2017, but if you are not ready by then, you can choose to start collecting performance data as late as Oct. 2, 2017. Whenever you start, performance data is due by March 31, 2018.






4. Why are there different starting dates? To make it easier for practices to comply with MACRA, CMS created four options, each with its own requirements.

·      Option 1: Test the quality payment program. As long as you submit some data-for example, one quality measure or one improvement activity-you can avoid a downward payment adjustment. You need to start collecting data no later than Oct. 2, 2017.

·      Option 2: Participate for part of the year. If you submit 90 days of 2017 data to Medicare, you may earn a neutral or small payment adjustment. You must start no later than Oct. 2, 2017.

·      Option 3: Participate for the full year. If you submit a full year of 2017 data to Medicare, you may earn a moderate positive payment adjustment. You must start collecting data Jan. 1, 2017.

·      Option 4: Participate in an Advanced Alternative Payment Models in 2017. Instead of reporting quality data and other information, the law allows physicians to join an Advanced Alternative Payment Model, such as a Medical Home Model. This can result in a 5% incentive payment in 2019.

·      Regardless of which option you choose, to earn the possible positive payment adjustment that starts Jan. 1, 2019, all 2017 data must be submitted by March 31, 2018.






3. What happens if I ignore MACRA? If you don’t send in any data, you will receive a negative 4% payment adjustment in 2019. This penalty increases each year thereafter: 5% in 2020, 7% in 2021 and 9% in 2022. 





2. Is this the last of the changes to MACRA? No. CMS indicated it will continue to listen to feedback and adjust rules as necessary and is already working on additional APM options to get more physicians involved.






1.  Is there any help available to help me with implementation? The Transforming Clinical Practices Initiative (TCPI) program offers assistance to transform your practice. Clink on the link to find organizations in your area that can help. http://www.healthcarecommunities.org/CommunityNews/TCPI/PTNMap.aspx


Help is also available through Quality Improvement Organizations:


For more information about MACRA: https://qpp.cms.gov/



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