What is MACRA?
MACRA is the Medicare Access and CHIP Reauthorization Act. MACRA replaces the current Medicare reimbursement schedule with a new pay-for-performance program that’s focused on quality, value, and accountability. It was signed into law on April 16, 2015 by President Obama.
The Centers for Medicare and Medicaid Services (CMS) stated that MACRA enacts a new payment framework that rewards health care providers for giving better care instead of more service. MACRA combines parts of the Physicians Quality Reporting System (PQRS), Value Based Modifier (VBM) and the Medicare Electronic Health Record Incentive Program (MU) into one single program called the Merit-Based Incentive Payment System or “MIPS”.
What is MIPS?
MIPS is the name of a new program that will determine Medicare payment adjustments and is an acronym for the Merit-Based Incentive Payment System. Using a composite performance score, eligible professionals (EPs) may receive a payment bonus, a payment penalty, or no payment adjustment.
The Composite Performance Score is based on four performance categories:
- Resource use
- Clinical practice improvement activities
- Meaningful use of certified electronic health records (EHR) technology
Performance for MIPS started on January 1, 2017 and will annually measure eligible providers in four performance categories to derive a “MIPS score” (0 to 100). The MIPS score can significantly impact a provider’s Medicare reimbursement in each payment year from -9% to +27% by 2022. The four performance categories are weighted:
- 50% for quality (PQRS/VBM)
- 25% for Meaningful Use
- 15% for clinical practice improvement
- 10% for resource use
The points provided for each category will shift over time to place an increasing focus on more resource use.
MediTouch is MACRA-compliant and can support your success through the transition to the new payment model.
Our software will provide you with a MACRA-specific, real-time dashboard so that you can be aware (at any point of the reporting period) of how you’re performing in the three categories on which you will be reporting. The new MACRA-ready functionality will also identify ways in which you can take action, per patient, to improve your score.
Three MIPS Performance Categories comprising our MACRA dashboard:
- Quality (PQRS + VBM)
- Advancing Care Information (Meaningful Use)
- Clinical Practice Improvement Activities
Note: Resource Use (or Cost) will not require reporting. This will be calculated based on your claims.
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