MACRA User Group June 2016
Understanding MACRA, the New Medicare Payment Reform Law: In this 30 minute webinar, learn about regulatory details of the Medicare Access CHIP Reauthorization Act (MACRA) the new Medicare payment reform law and their implications on Merit-Based Incentive Programs (MIPs) and Alternative Payment Models.
Today, we’re going to cover a whole bunch of new acronyms, especially, MIPS: the merit incentive payment system. This is a three-part series, and today I will focus on the MIPS track. So, to provide some context there, there are two tracks that clinician people participate in MACRA . . .One track is MIPS, the other is Advanced APMs.
Any acronyms used in the government and industry . . . , so I want to make sure you all have these available to you. So you won't have to spend time writing these acronyms down, I've provided them both here and again in the resource section at the end of today's webinar. Hopefully, these will seem familiar to you, though, and you'll recognize most of them at this point.
"MIPS" stands for the merit based incentive payment system. There're really two components to this, and the first one is going to streamline three pre-existing programs. The Medicare meaningful use, the "PQRS" or physician quality reporting system, and the value-based modifier, or VBM, are all what's going to be common performance categories under MIFS. So, instead of these being three separate programs, they'll now be three separate performance categories under one program. Another performance category will be added, giving a total of four performance categories that will now make up your MIPS track or MIPS form. I'll add here that CNS is really made a big effort to make MIPS and MACRA in general more flexible, and provide a lot more activities and measures than currently exist under this program, and have really tried to focus on clinician and provider group input.
And who is eligible to participate in MIPS? For years one and two, physicians, physician’s assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists are all eligible in years one and two. What I do want to point out here is that in years three onward, the health and human services secretary actually has the option, and likely will expand on that list, but the ones you see listed there are the ones CNS has subjected, so there might be some on that list that won't be included, and some that aren't on this list that will be added later, so, if you don't meet years one and two, just keep an eye out, and make sure you have MACRA on your radar, because there is a chance you could be included in future years.
Now that we know who's not, or who is eligible to participate, who is not eligible to participate? So there are two exemptions here: so, if you're a first year Medicare Part B participant--that typically applies to those that are fresh out of med school, but, that being said, if you are participating in even your second year of Medicare Part B, you will then be eligible for MIPS. Those that have a low, low patient volume threshold--that means ten thousand or less in medicare billing charges, and you care for a hundred or less patients in one year. So, it's important to note that that's an "and", not an "or." Also those who are participating in that advanced APM track--so that second track that we'll cover next week--if you fall into that, you are not eligible to participate in MIPS. I'll also note here that this does not apply to hospitals or facilities. That being said, some clinicians will still be eligible for MIPS in that focus on an ambulatory setting. So, they can bounce back and forth between, hospitals, facilities in an ambulatory setting, and these other categories don't meet them as an exemption, they'll still be eligible for MIPS, but that won't impact the hospital's or facility’s medicare reimbursement, it will only impact that specific physician's reimbursement.