The U.S. economy spends a total of 18% on healthcare currently, which is projected to grow by 5.8% per year in upcoming times. Cardiac services account for 40% of the Medicare budget and 60% of revenue in most cardiology practices.

Current Scenario

Post a spell of utmost confusion and tumultuous US elections, CMS is all geared up for a stepwise implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The act was passed by Congress with bipartisan support in April 2015 in order to replace the SGR. MACRA can be counted in the most phenomenal change in Medicare policy since its introduction 50 years ago. The act will also bear deep-running effects on all medical specialties and cardiology in particular.


As an act MACRA aims to control federal expenditures on health care. It focuses on issues like fundamental changes in how payments are made to physicians, focusing on modifying the current fee-for-service system that rewards increasing volumes of services and rather emphasizes on the quality and value to the Medicare recipient.

Provisions: MIPS and APMs

MACRA offers two distinct pathways that allow modification of the traditional fee-for-service model currently in place.


The Merit-based Incentive Payment System (MIPS), is a kind of program that provides incentive payments for participation in various clinical practices like quality improvement and reporting activities.


The Alternative Payment Models (APMs), allow lump-sum incentive payments for episodes of care, bundling all services delivered to a patient with a specified illness during a specified period.

Quality Indexes

MACRA changes mostly aim at focusing on the quality of care. Hence, cardiology revenue at most practices is likely to be negatively affected, if the quality indexes are not dealt with. Cardiologists opting for MIPS need to choose the six quality measures that they will submit for the MIPS quality category. They also need to understand their own position against national benchmarks.

To improve your Clinical practice you need to evaluate your patient access, population management, care coordination, and patient engagement. Working in close association with the billing administrator practices need to decide where in their workflow they will be pulling the data for each quality measure. With MIPS at your cardiology practices, the electronic systems need to be revisited to ensure that fields are mapped correctly.

This helps the cardiologists to get credit for their quality activities, thus improving revenues. Clinicians successful at reporting data across all MIPS categories for at least 90 days, or ideally, the full 2017 calendar year will be eligible for bonuses. Credit is also given for activities such as participation in clinical data registries, documented application of appropriate use criteria (AUC), and use of protocols promoting patient safety and patient satisfaction.

New Complex Rules

Even before the advent of MACRA, cardiologists found it difficult to collect resources and assemble an infrastructure needed to comply with the increasingly complex business and clinical demands of contemporary cardiology practice. Analysis of provisions of the new act shows how rules surrounding Medicare payments for cardiac treatment are very complex and are likely to adversely affect Cardiology revenue.

Many uncertainties exist surrounding the accuracy, attribution, and expediency of various quality, process, and outcome measures used to calculate the value for MIPS incentive payments, and for definitions of who and what is included, and for how long, in episodes of bundled care.

Key Reports and Records

To improve the revenue of their practices, Cardiologists should take the time to look themselves up on CMS official website. These Compare reports allow individuals to check their scores on various measures, putting light on the whole picture. Quality and Resource Use Reports (QRURs) include their readmission rates.

Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. To know more about our cardiology billing and coding services, contact us at

Published By - Medical Billers and Coders
Published Date - Aug-09-2017 Back

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