With MACRA moving into effect, healthcare organizations must know if they are ready and prepared for maximizing their revenue. In addition, it is necessary for organizations to be aware of the potential penalties and revenue implications that a lack of preparation for MACRA can bring about.
MACRA (Medicare Access and CHIP Reauthorization Act) is a new quality program from CMS (Centers for Medicare and Medicaid Services) designed to move healthcare for Medicare patients from volume to value through new weights and measures . MACRA is effective starting January 1, 2017, with payment impacts visible in 2019, and it offers reporting under MIPS (Merit-based Incentive Payment System) or APM (Alternative Payment Model) for larger practices that carry more risk.
MIPS combines the former VM (Value Modifier), PQRS (Physician Quality Reporting System), and MU (Meaningful Use) systems into a composite score, which determines reimbursement modifiers from part-B Medicare payments to clinicians. Based on the new measures, payments from CMS can result in negative expenses/penalties. However, there is upside potential for those who have stronger scores.
MACRA will repeal the old formula, and will reward providers for giving better care – not just more care. Many healthcare facilities are unaware of the new rules, and a lack of knowledge in this regard can mean organizations are more likely to be impacted with negative payments. Finding the composite score of your organization’s weights and measures can be quite complex, so having a vendor partner who can compute what the impact will be for your healthcare facility can be greatly beneficial.
Healthcare technology vendors need to be prepared for the impact that MACRA will have, and must understand what goes into its corresponding performance categories and payment tracks. Are you aware of the existing quality programs, and how they will change due to MACRA performance categories, for example? Do you know what it will mean for maximizing your payments?
The HCI Group knows what goes into the reporting categories for MACRA, as well as how scoring is done. We can determine if your organization is eligible, and which systems they need to be reporting under. HCI can provide:
If your organization wants to maximize its Medicare payments through MACRA, make sure to contact us today to learn our 4 Phase Model for MACRA implementation.
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