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Jacquelyn Sommer

, National Council for Behavioral Health

Physicians Paid Under Medicare Get More Time to Adjust to Reporting Requirements

September 15, 2016 | Medicare | Comments
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Providers will now have a year to adjust to the quality measures tied to their reimbursement rates under Medicare.  Centers for Medicare and Medicaid Services (CMS) continues to announce new guidelines ahead of the Medicare Access and CHIP Reauthorization Act (MACRA) final rule expected by November 1st.  In this latest announcement, CMS announced a more flexible approach to the roll out of MACRA, allowing clinicians to essentially “pick their pace of participation” in the upcoming year.

MACRA made sweeping reforms to how physicians are paid under Medicare, implementing a new Quality Payment Program.  The Quality Payment Program (QPP) has two parts:  Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (Advanced APMs). Both mechanisms focus on moving from payment for volume to payment for quality and value, and non-participation will result in reductions in reimbursement. The specific group of physicians who bill Medicare Part B will be subject to MIPS in 2017.  For more information on MACRA and clinicians who are eligible for participation check out our webpage.

The new approach to the implementation of these quality reports for the CY 2017 will allow selected Medicare Part B providers to pick from four different levels of participation:

  • Testing Only – Clinicians now may elect a “testing” option through which as long as some quality data is submitted via the QPP, including some from after Jan. 1, 2017, no negative payment adjustment will apply in 2019. CMS says this will ensure that clinicians “system is working and that you are prepared for broader participation in 2018 and 2019 as you learn more.”
  • Partial Calendar Year – Clinicians newly may opt to submit data to the QPP for a “reduced number of days.” Under this option, clinicians’ 2017 performance period could begin after Jan. 1, 2017, and their 2019 payment implications could still be a “small positive payment adjustment,” CMS indicates.
  • Full Calendar Year Participation – Clinicians may, as originally envisioned, submit QPP data for the full 2017 calendar year, effective Jan. 1, 2017, and receive a “modest positive adjustment.” CMS says this option is for practices that have readiness to proceed.
  • Alternative Payment Models – As statutorily specified and further discussed in CMS’ April 2016 proposal, practices may participate in eligible APMs, receive bonuses and differentially higher later updates, and forego quality reporting under MIPS that is required under all other options.

Stay tuned to the Capitol Connector for more MACRA updates and in case you missed it or if you want to take a deep dive into the details, the National Council hosted three webinars on MACRA!  Also, check out our webpage outlining MACRA and the implications these reforms could have on your organization.