MACRA (Medicare Access and CHIP Reauthorization Act) requires all clinicians who 1) bill Medicare more than $30,000 in Part B-allowed charges, or 2) provide care for more than 100 Medicare Part B beneficiaries to report specific data under the Quality Payment Program via either MIPS (Merit-based Incentive Payment System) or an Advanced Alternative Payment Model (APM).
Advanced APMs
Clinicians eligible for the Advanced APM model should have been specifically notified. Clinicians that have not yet been notified can visit https://qpp.cms.gov/ and enter their NPI number to verify their participation status.
MIPS
In order to avoid a potential negative payment adjustment in 2019, MIPS-eligible clinicians must submit data for 2017. These clinicians have been able to “pick their pace” for recording/submitting data this year in order to help with the transition.
| Option | Submit for 2017 | Earn/Receive in 2019 Payment Year |
| Nothing | No data | 4 percent payment NEGATIVE adjustment |
| Test | One quality measure or improvement activity for any point in the year | Neutral (no negative or positive payment adjustment) |
| Partial | 90 continuous days of data * | Up to a 4 percent POSITIVE payment adjustment |
| Full | Full year of data | Up to a 4 percent POSITIVE payment adjustment |
* The last day to begin recording data for a continuous 90-day reporting period (and attempt to earn up to a 4 percent POSITIVE payment adjustment in 2019) is October 2, 2017.
MIPS Score
A clinician’s MIPS Score is used to determine the percentage of positive payment adjustment he/she will receive in 2019. The 2017 score is calculated based on the clinician’s reporting of the three categories of data submission requirements:
- Quality Measures: 60 percent (report up to six measures)
- Improvement Activities: 15 percent (attest to the completion of up to four activities)
- Advancing Care Information: 25 percent (the five “qualifiers” must be accomplished; then additional points can be earned through performance measures and bonus credits)
Confused by all of these MACRAnyms? Give us a call. We’d be happy to help you with these reporting changes.