CMS releases MACRA final rule

CMS Press Release: MACRA Quality Payment Program Final Rule (CMS-5517-F)

On Friday October 14th 2016, the Centers for Medicare Services (CMS) released the final rule for the Medicare Access and CHIP Reauthorization Act, a landmark payment system for Medicare physician fees that replaces the sustainable growth rate formula. The 2,204 page rule now open for comments, finalizes the new payment and healthcare quality reforms for those physicians seeking reimbursement for services by Medicare.

The Quality Payment Program has two tracks you can choose from:

  1. The Merit-based Incentive Payment System (MIPS) If you decide to participate in traditional Medicare, you may earn a performance-based payment adjustment through MIPS.
  2. Advanced Alternative Payment Models (APMs) If you decide to take part in an Advanced APM, you may earn a Medicare incentive payment for participating in an innovative payment model

When does the Quality Payment Program start?

If you’re ready, you can begin January 1, 2017 and start collecting your performance data. If you’re not ready on January 1, you can choose to start anytime between January 1 and October 2, 2017. Whenever you choose to start, you’ll need to send in your performance data by March 31, 2018. The first payment adjustments based on performance go into effect on January 1, 2019.

How will the Quality Payment Program change my Medicare payments?

Depending on the track of the Quality Payment Program you choose and the data you submit by March 31, 2018, your 2019 Medicare payments will be adjusted up, down, or not at all. The information provided below is only relevant for the 2019 payment year. CMS will provide additional information on payment adjustments for 2020 and beyond beginning next year.

Track 1 – Pick your pace in MIPS: If you choose the MIPS track of the Quality Payment Program, you have three options.

pick your pace

The size of your payment adjustment will depend both on how much data you submit and your quality results.

Track 2 – Participate in the Advanced APM track: If you receive 25% of Medicare covered professional services or see 20% of your Medicare patients through an Advanced APM in 2017, then you earn a 5% Medicare incentive payment in 2019.

participate in the advanced APM track

CMS Resource Links