Medical Billing Outsourcing

MACRA Implementation

The subcommittee of the House Energy and Commerce Committee met on April 19 to hear testimonies from physicians about progress in MACRA implementation. This is the second such hearing, following one, where there was testimony from CMS.

MACRA steps into the stead of the long maligned Medicare Sustainable Growth Rate Formula (SGR), as the official method to calculate annual Medicare reimbursement adjustments for physicians. The new system serves the option for providers to pick one of two reimbursement systems to participate.

The first of these is the Merit-based Incentive Payment System (MIPS), which brings together and refines the current three Medicare Quality programs (PQRS, Value Modifier, and EHR MU), giving a single program where providers will receive a single score that decides whether they get a positive or negative payment adjustment. This payment adjustment will go up from four to nine percent in the period between 2019 and 2022.

The second option providers have is to take part in an APM, which is broadly defined as a non-fee-for-service system, where physicians hold the financial risk and accountability for quality of care provision. At this time, APMs are mainly seen in the forms of Accountable Care Organizations and bundled payment initiatives.

Outsource Medical Billing

Incentive Payment System

Some days following the hearing, CMS let out its proposed rule where it starts the process of laying out the details, definitions, and criteria for MIPS and APMs. The committee members employed the hearing as a means to push providers to start prepping for MACRA, and Subcommittee Chairman Joe Pitts (R-PA) made an opening speech suggesting that providers start developing internal processes and modernization improvements while waiting for the release of the proposed rule, which will be finalized by the end of the year. He said that practices should start assessing the two payment options and pick the one that suits them best.

Witnesses at the hearing unanimously agreed that the move to MACRA would be hard on physicians as well as the patients they are treating, and stressed on the importance of making the new payment methods more flexible. Each practice should be given a number of choices to pick the best one for their business. Also, witnesses noted that several existing physician complaints need to be addressed for the successful implementation of MACRA. The persisting issues here are EHR expense and interoperability, and a harrowing number of quality measures practices must track and report.