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– Arien Malec, Vice President, McKesson RelayHealth1
Compliance with the Medicare Access and the Children’s Health Insurance Program Reauthorization Act (MACRA) Quality Payment Program (QPP) can lead to positive or negative adjustments for Medicare reimbursement.To help avoid negative adjustments in 2019, most2 practitioners will need to start reporting data in 2017. You can select one of these options for the 2017 reporting year3:
If you submit a minimum amount of 2017 data to Medicare (for example, one quality measure or one improvement activity for any point in 2017), you can avoid a downward payment adjustment.
If you submit 90 days of 2017 data to Medicare, you may earn a neutral or small positive payment adjustment.
If you submit a full year of 2017 data to Medicare, you may earn a moderate positive payment adjustment.
Participate in an Advanced Alternative Payment Model, such as Medicare Shared Savings Track 2 or 3, in lieu of reporting quality data to the Quality Payment Program. For those required to report, doing nothing will result in penalties.
You’re not alone. A recent study4 found that only half of the physicians surveyed were familiar with MACRA. Under MACRA, the QPP introduces important changes for Medicare reimbursement, including MIPS and APMs.
The proposed rule allows clinicians to choose measures and activities appropriate to the type of care they provide. MIPS allows Medicare clinicians to be paid for providing quality care demonstrated and measured in four performance categories:
Clinicians will report key measures of interoperability and information exchange. Clinicians are rewarded for
their performance on the key measures they select. Key measures include:
The Quality performance category replaces the Physician Quality Reporting System (PQRS).
Examples of quality reporting requirements include:
*These are actual code descriptions from CMS.