Yes Virginia, MACRA is real.

May 12, 2017
Mark Caron, Chief Executive Officer


Dear Editor: I am a practicing physician and some of my little friends do not believe MACRA is real. Please tell me the truth. Is MACRA real?  Is it going to impact my Medicare reimbursements?

Dr. Virginia O’Hanlon

Virginia, your little friends are wrong. They have been affected by the skepticism of a skeptical age.

Yes, Virginia, MACRA (Medicare Access and CHIP Reauthorization Act of 2015) is real and the choices you make today will impact your Medicare reimbursements very, very soon.

In fact, dear Virginia, the Centers for Medicare and Medicaid Services (CMS) began notifying clinicians of their eligibility on April 25. Don’t worry if you haven’t yet received yours; they are expected to take through the month of May. The notification will come to your practice from the Medicare administrative contractor who processes your Medicare Part B claims.

If you cannot wait, have your National Provider Identifier (NPI) number handy and click the image below to find out if you’re included in the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program:

To refresh your memory, dear Virginia, if you (or your little friends) are:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists

and you bill more than $30,000 in Medicare Part B allowed charges

and you provide care for more than 100 Part B-enrolled Medicare beneficiaries,

then, you are MIPS eligible. You must meet both the billing threshold and the number-of-patient threshold to be included.

Two exceptions: If this is your first year participating in Medicare, then you must wait until next year to join. Or, if you are part of an Advanced Payment Model (APM), then you will participate in the Quality Payment Program, but not the MIPS track.

Don’t delay any longer.

The clock is ticking, dear Virginia. If you are eligible and do nothing this year, you will suffer grave consequences.

It’s not too late, but you do need to make haste.

Your options for this year are flexible, but only for this year. Options are:

  1. Do nothing. Those who are eligible, yet do nothing, will receive a negative 4-percent adjustment to their 2019 Medicare reimbursement rates.
  2. Do something. Anything, dear Virginia. Just don’t ignore MACRA and hope it will go away. Reporting on a single measure will prevent the 4-percent negative adjustment and indicate you are ready to participate in the first full reporting year (2018).
  3. Do a little bit. Just a little more. Collecting performance data for any single 90-day period between Jan. 1, 2017 and Oct. 2, 2017 will qualify clinicians for a neutral or small upward adjustment.
  4. Do it all. Jump in with both feet, although it may be too late to collect the full year if you haven’t yet started. However, if you have the data, then reporting a full year of performance data will qualify you for a moderate upward adjustment.

As a physician, we know you have the capacity, but perhaps not a lot of spare time. However, we encourage you to learn all you can about MACRA’s quality payment program. Please, dear Virginia, keep in touch and do let us know how you are getting on with MACRA, MIPS and all the rest.

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