The terms MACRA and MIPS have been flying through the healthcare industry for sometime now, yet many providers don’t seem to know the difference between them or what the programs are for. Let’s face it, it’s confusing information. The Centers for Medicaid and Medicare Services (CMS) have been implementing different versions of Meaningful Use, PQRS, and other acronyms to entice practices to switch to Certified Electronic Health Records Technology(CEHRT) rather than paper documents. Luckily, we have broken it down for you in the simplest way possible.
The Medicare Access and CHIP Re-authorization Act, more commonly referred to as MACRA, shaped the new incentive program which combines previously known programs including Physician Quality Reporting System (PQRS), Value-based Payment Modifier, and Meaningful Use (MU). This 2017 change meant that reporting for the first performance year in 2019, began. This means come 2019, you will either receive incentives or penalties from your participation in MACRA from 2017. If you are an Eligible Clinician (EC), there are two paths that you can choose to follow in order to attest during 2017 — MIPS or ACI.
How Do I Know Which Path I Qualify For?
In order to determine which path you qualify for, you need to answer these two questions:
- Does your practice have $10,000 ≥ in Medicare charges AND 100 ≥ fewer Medicare patients annually?
- If the answer is yes, you can relax and take a deep breathe because you are exempt from MIPS participation
- If the answer is no, than you qualify for MIPS or potentially APM
Have your NPI number ready? Click here to determine your participation status.
- Does your practice participate in an Accountable Care Organization (ACO), Clinically Integrated Network (CIN) or another entity of that applies and qualifies as a APM?
- If the answer is yes to both questions, then you qualify for not only MIPS but APMs as well
- If you answered yes to number one and no to number two, then you only qualify to participate in MIPS
- If neither but you participate in another APM entity, contact you entity’s administrators
The Merit-based Incentives Payment System (MIPS) is designed to help EC benefit from implementing a CEHRT. MIPS allows practices to choose their own rate of participation – positive, neutral, and negative adjustments – that must be reported on in 2017, to see results in 2019 . These 3 categories include:
- Advancing Care Information
- Improvement Activities
Each category has a specific number of measures that must be met, which collectively display your MACRA score that affects your pay out in 2019.
How will my participation this year affect me in the future?
Your participation score from this year, will start affecting your practice in 2019 between -/+ 4%. This percentage will increase over time:
Want to see how RxNT|EHR can help you meet MACRA requirements? Download our manual now!
To learn more about MACRA/MIPS check out these related posts: