If it’s 2017, then it must be time for MACRA/MIPS

If it’s 2017, then it must be time for MACRA/MIPS

After almost two years of preparation, the Quality Payment Program portion of the Medicare Access and CHIP Reauthorization Act (MACRA) went into effect January 1, 2017. On October 14, 2016 CMS released the final rule for the program, which is designed to reduce the administrative burdens on physicians and promote patient-centered, value-based care.

The initial MACRA legislation was passed in April 2015 to create a quality payment program that compensates providers who see Medicare patients. A year later CMS released a proposed rule on the law, which included the two initial pathways for provider participation: The Merit-based Payment System(MIPS) and the Advanced Alternative Payment Model (APM).

MIPS is designed for groups that largely operate under traditional fee-for-service models and is the pathway for the majority of providers. MIPS participants have the opportunity to earn up to four percent (or lose up to four percent) on their 2019 reimbursement, based on their 2017 performance. The incentive and penalty rates increase to nine percent by 2022.

The APM track is for practices that primarily operate in alternative payment programs. To be approved by CMS as an APM, qualifying programs must use certified EHR technology; base payments on quality measures comparable to MIPS; and require their providers to bear more than nominal risk. APM participants are eligible for a five percent bonus incentive in 2019. CMS estimates about five to eight percent of clinicians (about 120,000) will participate in Advanced APMs in 2017.

As we outlined in this blog post, CMS announced in September a number of updates to the proposed rule, most notably that practices could “pick their pace” in complying with the law. The “pace” indicates the level of clinician participation: the higher level of participation, the bigger the potential positive payment adjustment. Clinicians opting not to participate are subject to an automatic four percent payment adjustment. The 2,400-page final rule spells out additional details on the different participation options and highlights CMS’s efforts to streamline the program.

One thing to keep in mind is that MACRA actually combines several existing programs, such as Meaningful Use, PQRS and the Value-based Modifier program. If you have already been participating in any or all of these, you have a head start towards achieving MACRA success.

Here are a few more fast facts to help you get a handle on MACRA:

  • All providers, including physicians, PAs, NPs, clinical nurse specialists and certified registered nurse anesthetists, who bill Medicare more than $30,000 per year, or provide care for at least 100 Medicare patients, qualify for MACRA. An estimated 642,000 eligible clinicians will be required to participate in MIPS for the 2017 performance period.
  • Participating providers will be issued a composite score based on performance across four areas: quality, cost, care coordination and EHR use.
  • At a minimum eligible clinicians must report on at least one measure or activity within MIPS for 90 days in 2017 or risk a four percent payment adjustment in 2019. By reporting on at least one measure a practice may not see an increase in reimbursement, but they can avoid being assessed a penalty for 2019.  
  • More than half of eligible clinicians who bill under Medicare are exempt from MIPS for the 2017 performance period. This represents up to 780,000 clinicians that either don’t meet the $30,000 threshold for allowed charges or serve less than 100 Medicare patients.

One additional thing we are certain of in regard to MACRA: clinicians must have a certified EHR to achieve success. Practices should ideally partner with a company that has a proven track record of compliance with government initiatives and that offers a MIPS-ready platform.

Aprima is ready. While MACRA/MIPS might look like a looming shadow, in reality you are well on your way to success if you’re equipped with a solid EHR and the support of a company, like Aprima, that can provide you with the expert guidance you need. 

For practices needing help, Aprima’s consulting services can assist you with:

  • Workflows to accommodate the seamless recording of “advancing care” activities
  • Verification that you are capturing all your clinical practice improvement activities
  • Helping to ensure that users know how to monitor and control utilization and cost
  • And much more

Be assured that the Aprima system meets the required functionality for MIPS today and will continue to meet the required functionality for future year MIPS upon completion of Meaningful Use Criteria 2015 Certification in 2017 for the Aprima EHR/PM. In addition, our platform already has the functionality required to address the component parts of MACRA, including Meaningful Use and PQRS, plus the requirements for the Value-based Modifier program. We’ll guarantee it!*

Want to learn more? Contact an Aprima representative at or call 844 4APRIMA.

Neil Simon, Aprima COO

*This guarantee is subject to additional terms and conditions. Check with Aprima for specifics. The opinions/ideas expressed here do not constitute legal advice, and independent advice should be sought by the reader at his/her own discretion.





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