MACRA/MIPS

The deadline for accumulating the minimum data to ensure that your organization does not receive a negative adjustment to your Medicare Part B reimbursement under MACRA in 2019 is December 31, 2017.  Starting in 2018, you will need to collect data for certain categories for the entire year to mitigate the risk of a negative payment adjustment in 2020.

What is MACRA?

The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, is a bipartisan legislative act that was enacted on April 16, 2015. This law initiated drastic changes in the way physicians, and certain other providers are, and will be, paid. As part of a larger push to value-based payment methodologies, MACRA established two payment tracks, the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). If you qualify under MACRA for one of these two payment tracks, your Medicare Part B payments will be influenced in future payment years depending on data that you submit, or do not submit, in a quality reporting year to the Centers for Medicare & Medicaid Services (CMS).

Adjustments to Medicare Part B payments, both negative and positive, will begin in calendar year (CY) 2019 based on CY 2017 data. The percentage of payments subject to performance evaluation will gradually increase as the program continues, resulting in greater risk being shifted to the provider. Whether an eligible clinician (EC) realizes increased or decreased reimbursement will depend largely on how they have prepared themselves in the move from volume to value based payments.

How can BNN help?

Preparing for MACRA can be a complicated process as there are many variables to consider. Without the proper knowledge, it is possible to waste countless hours on the various components of MACRA. We specialize in MIPS implementation. As such, BNN professionals can help you operationalize MIPS by:

  • Determining if you qualify under MIPS
  • Providing education
  • Performing a MIPS readiness assessment
  • Performing a MIPS initial impact assessment
  • Providing MIPS implementation assistance
  • Providing ongoing support

Our healthcare team has extensive experience in the areas of Medicare reimbursement, regulatory compliance, revenue cycle, and financial impact analyses, allowing us to provide the highest quality service to your organization. Contact us today to see how we can help you.

Baker Newman Noyes MACRA Overview

Download our complimentary, in-depth MACRA overview to learn more and help get your organization on track for a successful implementation. You’ll also receive updates and other helpful articles from our healthcare industry practice.

Related Resources   (Read More in Our Library)

Lead Contacts

D. Eric Wetherell

Principal

Eric specializes in leading multidisciplinary teams in the development of long-range financial and strategic plans and the performance of financial feasibility studies to support strategic decision-making.

Robert Gilbert

Senior Manager

Rob is a senior manager in the healthcare consulting practice, specializing in operational areas including charge capture, revenue cycle, revenue integrity, charge master, claims, provider reimbursement, and business systems.