Answers to Some MACRA FAQs for Health Practitioners

 

MACRA (The Medicare Access and CHIP Reauthorization Act) was established in 2015. It repealed the sustainable growth rate formula replacing a broken, frustrating and needlessly unpredictable system. This transition stabilizes Medicare payments and has the potential to reward physicians for what they do best— providing quality, high-value care. MACRA provides education materials to customized practice insights, and help health practitioners get a clear view of their payment model options and their practice’s financial wellness throughout the payment and care delivery reform process. This article addresses some MACRA FAQs to assist health practitioners and clinicians navigate this transition seamlessly.

 MACRA has established reporting demands that are very complex and hard to comprehend. MACRA comprises of over 2,400 (two thousand four hundred) pages of regulations. This makes it hard for physicians, nurses and health practitioners to interpret and understand these regulations and their implications. Failing to meet these requirements will have drastic implications on their organizations so understanding it is crucial.

MACRA FAQS

  1. Why is MACRA necessary?

  2. How do payments work?

  3. Who is required to participate?

  4. What if I don’t report at all?

  5. If I work in a large organization, do I need to worry about preparing for MACRA?

  6. Should I report as an individual or group?

  7. What about multi-specialty practices?

 

Why is MACRA necessary?

MACRA is necessary because systems in the past subjected doctors to negative payment adjustments and unfair penalties. MACRA stabilizes the reimbursement landscape and regularizes penalties reducing it from 11%(which is outrageous) to 4%.

How do payments work

MIPS will be eligible for positive or negative Medicare Part B payment adjustments that start at 4% and gradually increase to 9%. This payment method will start in 2019 and go on till 2022. This payment distribution will be made on a  sliding scale and will not be affected by the budget. I.e it will be budget neutral. Instead, the payment adjustment will be made on a sliding scale and based on:

  • Physicians with a final score at the threshold will receive a neutral payment adjustment.
  • Physicians with a final score above the threshold will receive a positive payment adjustment on each Medicare Part B claim in the payment year.
  • Physicians with a final score below the threshold will receive a negative payment adjustment on each Medicare Part B claim in the payment year.
  • Physicians with a final score in the lowest quartile will automatically be adjusted to the maximum negative adjustment on each Medicare Part B claim in the payment year.

Who is required to participate?

MACRA is not just for Physicians. It’s also required for Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, and groups that include clinicians who bill under Part B. Individuals who bill Medicare more than $30,000 and anyone already part of an Advanced APM will also participate.

What if I don’t report at all?

Those who don’t report will not only have to pay the 4% fine but also face potential impact on their reimbursement, future job search efforts and lost reputation with potential patients.

If I work in a large organization, do I need to worry about preparing for MACRA?

Yes.

Should I report as an individual or group?

MACRA defines a group as a single Taxpayer Identification Number (TIN) with two or more MIPS eligible clinicians, as identified by their individual National Provider Identifier (NPI), who have reassigned their Medicare billing rights to the TIN. If you don’t fit this requirement then you should report as an individual.

What about multi-specialty practices, should they report as a group?

Most practices find it beneficial to report as a group as reporting individually will be a tedious process. Reporting as a group makes it relatively easier to achieve measures, such as care coordination, that require effective communication among providers, patients, and specialists. Everybody can participate in this.