by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
September 9th, 2016
What in the world is MACRA, MIPS and APM? More acronyms, rules and payment changes are headed our way. If you are a Medicare Part B provider, you will want to pay special attention.
MACRA- Medicare Access and CHIP Reauthorization Act of 2015
MIPS- Merit-Based Incentive Payment System
APM – Alternative Payment Model (Incentive under Physician Fee Schedule)
MACRA repeals the Medicare sustainable growth rate (SGR) methodology for updates to the Physicians fee schedule and replaces it with a new merit based payment system (MIPS).
We are all aware of PQRS, the next step is to combine parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-Based Payment Modifier) and the EHR incentive program into one program called the Merit-Based Incentive Payment System (MIPS). Based on performance providers will receive an increase or a take a pay cut in their Medicare Part B payments. Just like other programs MIPS will be based on a performance score that is determined by the measures that will be established under MACRA Rules.
This new rule is offering great incentives for participation with Medicare Part B payments increasing each year from 2019 until 2022 when adjustment levels will stabilize. In 2019 your payment structure will start at +4% to -4% until 2022 with rates at +9% to -9%.
The plan for implementation for MIPS payment adjustments are seen below, however, keep in mind there are rumors about not starting until 2018. These statutory changes if implemented in 2017, will determine payment starting in 2019.
- 2019 – Providers subject to -4% to +4% base rate adjustment for Medicare Part B reimbursements
- 2020 – Providers subject to -5% to +5% adjustment
- 2021 – Providers subject to -7% to +7% adjustment
- 2022 on – Providers subject to -9% to +9% adjustment
Additionally if a provider chooses to participate in Alternative Payment Models (APMs) they may be eligible for an annual 5% lump-sum bonus payment from 2019 through 2024.
MACRA also requires CMS to remove Social Security Numbers from all Medicare cards, by April 2019 CMS will send out a new number to all people with Medicare. The SSN’s will be replaced from existing Medicare Health Insurance Claim Numbers (HICNs) with a Medicare Beneficiary Identifier (MBI). The MBI will be a randomly generated identifier that will not include a social security number or any personally identifiable information (PII).