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MACRA Compliance Requirements

It is reported that doctors are potentially facing loss of millions of dollars in Medicare reimbursement. This is due to the lack of MACRA-related guidance from the CMS, says a letter from the Medical Group Management Association (MGMA) to the CMS.

In a final rule that was announced last year, CMS said that they would exempt those physician practices, which have less than thirty thousand dollars in Medicare charges or less than hundred unique Medicare patients every year, from complying with the MIPS plan that is outlined under the MACRA. CMS was supposed to notify these physician practices and doctors formally in December 2016.

As per the analysis of an American Medical Association, the threshold in the final rule of CMS would exclude thirty percent of the physicians from complying with the MIPS. However, three months into the first year of implementation of MACRA, doctors have not yet received any notifications. This leaves the doctors vulnerable and CMS can later tell that they are on the hook to comply with the law.

“This is generating considerable frustration and confusion,” MGMA said in their letter to the CMS. Under the MIPS program, physician pay will be based on the success of the practice in four categories to evaluate performance. These categories are resource use, clinical practice improvement, quality, and advancing care information, making use of the health information technology. The latter is based on the Meaningful Use program, which was used by the federal government to decide if the doctors need to be rewarded for making use of the electronic health records.

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Medicare reimbursement for the healthcare providers in 2019 will be based on how well the physicians and doctors perform on the performance metrics. It is reported that under the MIPS doctors and physicians can earn plus or minus four percent of the Medicare reimbursement in 2019.

A spokesperson from CMS said that they are planning to send out the notifications in this spring. Nonetheless, the representative refused to comment on why they missed to meet the December deadline.

MGMA said that the answer from CMS is not acceptable as the doctors are looking for immediate answers. “Physicians need certainty to make timely business decisions about investments in technology, clinical systems and the staff necessary to comply,” said Anders Gilberg, senior vice president of government affairs at the MGMA.