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Medicare Changes

What are the changes to current Medicare reporting and reimbursement?

Currently, the Medicare program measures the value and quality provided by physicians and other eligible clinicians through a patchwork of programs, including the Physician Quality Reporting System, the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program. Under MACRA, these programs are streamlined into one: a Merit-Based Incentive Payment System (MIPS) Exit Disclaimer: You Are Leaving www.ihs.gov . MIPS allows Medicare clinicians to be paid for providing high quality, efficient care through success in four performance categories: Cost, Quality, Clinical Practice Improvement Activities and Advancing Care Information.

The law requires MIPS to be budget neutral. Therefore, eligible clinicians' MIPS scores would be used to compute a positive, negative or neutral adjustment to their Medicare payments. In the first year, depending on the variation of the MIPS scores, adjustments are calculated so that negative adjustments can be no more than 4 percent, and positive adjustments are generally up to 4 percent, with additional bonuses for the highest MIPS-scoring performers.

Eligible clinicians who participate in Advanced Alternative Payment Models (APMs) Exit Disclaimer: You Are Leaving www.ihs.gov  would be exempt from MIPS payment adjustments and would qualify for a 5 percent Medicare Part B incentive payment. Please vsit the CMS QPP website for more information about APMs.

When will these changes take effect?

Medicare payment changes will occur beginning in 2019.

The first year of implementation, CMS will measure performance for eligible clinicians through MIPS starting in January 2017, with payments based on assessment of those performance measures beginning in 2019.

Under APMs, starting in performance year 2019, eligible clinicians could qualify for incentive payments based, in part, on participation in Advanced APMs developed by non-Medicare payers, such as private insurers or stated Medicaid programs.