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Another Payment Reform? Harmony is here to help...

Posted August 1, 2016

What is the new payment reform?

This major piece of legislation was signed into effect on April 16, 2015 and is known as MACRA (Medicare Access and CHIP Reauthorization Act of 2015). Commonly used phrases, such as, “SGR Repeal” (sustainable growth rate formula) and “permanent doc fix,” are being used to describe MACRA.

MACRA moves to control healthcare costs by moving away from the fee-for-service system entirely and transition into one of two new value-based payment systems.

What are your options?

Beginning with the 2019 payment period, calculated on the provider’s 2017 performance, Medicare docs will need to participate in one of the of the following payment systems:

  1. MIPS – Merit-Based Incentive Payment System
  2. APM – Advanced Alternative Payment Model

How does MIPS work?

MIPS works to consolidate previous initiatives (Meaningful Use, PQRS, and value based modifier program penalties) into a new system, assessing providers in four categories:

  • Quality 50%
  • Advancing Care Information 25%
  • Clinical Practice Improvement Activities 15%
  • Resource Use 10%

Based on the provider’s performance in the above categories, he/she will receive an incentive or penalty when compared the national average of other providers (national baseline). See Below:

                                                                                                           
 

 

 

 

Certain providers may be exempt from MIPS if he/she receives a certain percentage of payments through qualifying advanced alternative payment models. CMS states, “Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models are some examples of APMs.”

How does APM work?

If the provider meets the minimum thresholds for alternative payment models, they will receive:

  • 5% incentive payment each year from 2019-2024
  • 0.75% annual increases beginning in 2025

 

These iniatives can be daunting.

Contact a Harmony Solutions Specialist today.

(800) 220-2685