The High Price of MACRA Mistakes | Geneia

The High Price of MACRA Mistakes

October 19, 2017
Heather Lavoie, Chief Strategy Officer

Penalty stamped over image of stethoscopes with quote

I’ve written and read a number of articles on how woefully unprepared eligible clinicians are for MACRA[i]. And yet, here I am, writing one more. Why? Because this is significant financially and I worry, considering the penalties levied against those who – for whatever reason – haven’t yet figured it out.

I’ve heard from some physicians who believed someone else at their practice was handling MACRA reporting. Unfortunately, a few simple inquiries revealed this wasn’t the case. Since MACRA penalties are levied against individual physicians and not necessarily at the practice as a whole, this assumption could have proved costly had it been left alone. 

Many physicians erroneously believe they need an EHR to comply with MACRA. You don’t. And the lack of one will not qualify you for an exemption.

Make no mistake in understanding MACRA’s scope and consequence:

  • MACRA is the biggest change to Medicare reimbursement in more than a decade.
  • Even with additional exclusions, we expect CMS to collect more in penalties than it will pay in bonuses.
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Eligible clinicians who do not report will be penalized four percent on every Medicare Part B claim in 2019.

  • For clinicians who meet the minimum threshold of $30,000 in annual Medicare Part B charges, the penalty is approximately $1,200
  • For clinicians with $125,000 in annual Medicare Part B charges, the penalty is approximately $5,000
  • For clinicians with $225,000 in annual Medicare Part B charges, the penalty is approximately $9,000

It’s easier than you think to avoid this costly penalty

Because MACRA builds upon existing programs (PQRS, MU3, VBM[ii]), many clinicians already collect the data and information needed to fulfill minimum reporting requirements that avoid the negative four-percent penalty.

There are two simple ways to avoid the penalty:

One: record a single quality measure for a single patient for any point in time during 2017. The quality measure must make sense for both the patient and the scope of your practice. You can report this single quality measure via the claims path (form CMS 1500).

Two: record a single high- or medium-weight continuous improvement activity that makes sense within the scope of your practice. Examples include patient safety and practice assessment (high-weight) and care coordination or population management (medium-weight). These examples do not require an EHR.

You Are Running Out of Time

The year is almost over. Take a few minutes to protect what you earn, before it’s too late. Your single quality measure or improvement activity information can be collected anytime between now and the end of the year.

While that may sound like plenty of time, it isn’t. The final quarter is always jam-packed with heavy appointment loads for people using up their benefits, health plans wanting end-of-the-year reporting, your own year-end appointments, and an assortment of holiday celebrations.

For additional insights and shortcuts on MACRA reporting to help you avoid the penalty, download our eBook: 4 Things Every Physician Needs to Know About MACRA, and 3 Things To Do RIGHT NOW!

[i] Medicare Access and CHIP Reauthorization Act of 2015

[ii] Physician Quality Reporting System, Meaningful Use, Value-Based Modifier

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