The Final 5 - MACRA Rule

The Final 5 - MACRA Rule


Published: October 31st, 2016

Five Facts to Know about the Final MACRA Rule

The Medicare Access and CHIP Reauthorization Act (MACRA) has been finalized and will affect all providers that care for at least 100 Medicare patients or bill more than $30,000 a year. CMS made some critical revisions to the previous bill which includes a more flexible start date in the first year. Adjustments were also made to the low-volume threshold for small practices, the advanced APM was established as a standard to promote participation in value-based care models, EHR requirements were simplified, and the medical home model was established to promote care coordination. Below are five important facts to know about the final MACRA rule: 

When does MACRA begin?

  • The program begins January 1, 2017, but providers who are not ready yet can begin collecting performance data anytime between January 1, 2017, and October 2, 2017. Regardless, the start date, performance data is due by March 31, 2018. Data collected in the first year will determine payment adjustments beginning Jan. 1, 2019.

What happens to providers that choose not to participate in MACRA? 

  • If providers fail to send their data, they will receive a negative 4% payment adjustment in 2019. The penalty increases each year to 5% in 2020, 7% in 2021 and 9% in 2022.

What are the options for provider participation?

  • The final rule includes two options for provider participation: Merit-Based Incentive Payment System (MIPS), and the Advanced Alternative Payment Model (APM). 

Have there been any changes made to MIPS?

  • The Merit-Based Incentive Payment System (MIPS) is a program that determines Medicare payment adjustments. What has changed in this program from the proposed rule is that in the first year, providers will not be assessed on cost or resource use. Once MIPS has been fully implemented then payment adjustments will be based on the following four categories: 
    • Quality (Physician Quality Reporting System)
    • Advancing Care Information (Meaningful Use)
    • Clinical Improvement Activities (New category)
    • Cost (Value-Based Modifier) 
  • Some experts believe postponing the cost category for a year will help ease the transition for providers. 

How does the final rule affect small practices? 

  • CMS has reduced the time and cost to participate, increased the availability of Advanced APMs to small practices, and are providing $20 million a year in outreach and technical support to small practices over the next five years.

For more information about MACRA: https://qpp.cms.gov/