October 2016

Today, the Centers for Medicare and Medicaid Services (CMS) released the final rule to implement the Medicare Access and CHIP Reauthorization Act – better known as MACRA.  The final MACRA rule will implement significant changes to Medicare reimbursement for Part B services by requiring nearly all Part B providers (physicians, physician assistants, nurse practitioners and other Part B providers) to participate in CMS Quality Payments Programs.  Providers with less than $30,000.00 in Medicare reimbursements or fewer than 100 Medicare beneficiaries will initially be exempt from participating in the CMS Quality Payments Program.  CMS estimates 32.5 percent of providers will meet the above participation exemptions.

Physicians can participate in the CMS Quality Payments Program in two ways:

1. Participating in an Advanced Alternative Payment Model (APM).  APMs include a variety of CMS approved payment models that require some form of risk sharing, incorporation of electronic medical records and quality improvement activities.

   Providers who successfully participate in APMs in 2017 are eligible for up to a 5 percent bonus payment in 2019.

2. Participating in Merit-Based Incentive Pay System (MIPS). Under MIPS, providers will be required to report on quality measures, practice improvement activities and use of certified EHR technology.

Providers who do not successfully participate in either program in 2017 will be subject to a 4 percent cut in 2019.  Providers who successfully submit at least 90 continuous days of data on 2017 encounters will avoid, at a minimum, the 4 percent cut in 2019 and may be eligible for a positive bonus.

To learn more about the rule, please visit the CMS Quality Payment Programs website. The ATS will closely review the final rule and provide further updates.