What do Providers and Medical Billers Need to Know about the Final MACRA Rule?

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What do Providers and Medical Billers Need to
Know about the Final MACRA Rule?
Indicating a departure from the volume-based,
fee-for-service model, MACRA now replaces the SGR
sustainable-growth-rate-formula to control
Medicare costs. The MACRA rule is all about
linking Medicare reimbursements to the quality
metrics with the medical billers which will be
now rewarded for offering value-based quality
services. MACRA revokes the set payment rates
based on economic growth, which was the hallmark
of SGR. On April 27, 2017, CMS released a new
proposed rulemaking for the MIPS and Advanced APM
models. Physicians and the entire practice will
now have an additional payment model. This makes
it possible to determine the best model in terms
of current performance. After a payment model
will be chosen, the physician will be responsible
for determining how to organize themselves for
the biggest advantage with the choice they make.
This requires an understanding of whats required
for success. MACRA revokes Medicare Part-B
Sustainable Growth Rate (SGR) reimbursement
formula and now replaces it with Merit-Based
Incentive Payment System. 85 of the Medicare
reimbursements must be tied to quality. To
accomplish this, the health care providers should
take part of an Alternative Payment Model or the
Merit-based Incentive Program System.
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What do Providers and Medical Billers Need to
Know about the Final MACRA Rule?

• What providers and medical billers and coders
  need to know about the final MACRA rule is now
  MIPS will measure Medicare Part B providers in 4
  varied categories. The providers will be scored
  on a scale from 1 to 100. Based on their score,
  providers will either get incentive, will be
  penalized, or remain neutral.
• Four categories of qualified clinician
  performance
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• Quality 60 for 2017
• Advancing Care Information which will be 25 for
  2017
• Cost 0 for 2017
• Improvement activities (CPIA) 15 for 2017
• Who gets affected by the new rule of MACRA?
• All providers, including mid-level practitioners,
  who have at least 100 Medicare patients or who
  bill Medicare at least 30,000 per year, will
  qualify for MACRA. If you are new to Medicare in
  2017, you will not have to report next year. You
  can begin reporting between January 1st and
  October 2nd, but all reports are due by March 31,
  2018. The first payment adjustments will begin in
  January 2019.

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What do Providers and Medical Billers Need to
Know about the Final MACRA Rule?
How a small practice participates in
MACRA? Small practices can join virtual groups
to submit MIPS data collectively if they do not
meet the minimum volume for participation. The
rule assigns 20 million for education and
training for practices of fewer than 15
physicians and those in under-served
areas. Bottom Line Ultimately, MACRA is going to
require a great deal from practices. Its a
costly change that might not be able to be
tackled by one physician or even within a single
practice. More than likely, its going to lead to
physicians beginning to team with other doctors.
They may even join with an affiliating health
system in order to take advantage of
performance-based payment. As of the summer of
2016, doctors are collaborating to form
clinically integrated networks, also known as
CINs. A CIN is a group of physicians and health
systems working together, and its going to be
much more common as the year continues and even
as the years pass. Medical Billers and Coders
(MBC) is a leading medical billing company
providing complete revenue cycle solutions. To
know more about our medical billing and coding
services, contact us at info_at_medicalbillersandcode
rs.com/888-357-3226.