Medical Billing ServicesRevenue Cycle Management (RCM)

Should Doctors Stand Against or with MACRA?

Ever since the election of President Donald Trump the healthcare industry is reeling under the pressure of changing regulations and norms. Right from small healthcare units to large medical facilities and from outsourced medical billing and coding companies to insurance providers, all are feeling the heat.

However, the President’s succeeding choice of a former orthopedic physician, Tom Price, MD, did raise hopes among the independent physician community that relief may become. But as of now, there is no better embodiment of untenable regulations that have little to do with patient care than the Medicare Access and CHIP Reauthorization Act (MACRA).

For those who are still blissfully unaware (and there are many) MACRA is a program seeking to transition the physician community to payment based on performance and value. This is a well-intentioned goal and one that many healthcare experts supported at its inception and for many years after. To put it in simple terms, the implementation leaves much to be desired. Also, the persistence to stay the course despite evidence and anecdotes to the contrary has forever cured the experts of the idea that the future of healthcare could ever safely lie in the hands of well-intentioned bureaucrats.

So, coming to the main question, Should doctors stand against or with MACRA?

As it looks now, there are a number of requirements and suggestions for doctors to be aware of. A reported 84 percent of independent or solo doctors and staff are uncertain of what MACRA demands of them.

Be open to securitize Individual Performance Data and Transparency

The new MIPS system more or less is focused on giving a single score to each individual doctor. All MIPS scores and individual category marks will be posted on the CMS Physician Compare website. The posted scores will give an idea to healthcare providers as to where they fall in the distribution of their peers across the country.

To flourish under the new physician rules they will need to collaborate with their health systems and groups to start thinking of well-organized ways to measure individual performance. Doctors will not just need to get used to getting measured, but they should also know their performance will be available to consumers. This is due to the case of CMS moving towards using transparency to improve performance.

Comprehend the Consequences

The Fee-for-service reimbursements will be shifted away from and doctors should be aware of how this will affect their facilities bottom line. In a time where medical facilities are encountering a large number of patients every month, the shift from quantity to quality service can be stunting. Under MACRA there is also the potential for penalties to accrue over the years. From the year 2022, the potential financial loss from groups that don’t report data could jump from two to nine percent. This is depending on how well the doctor’s score in the four performance categories.

In another scenario, doctors who score extremely high will also be eligible for a 27 percent payment bonus over a three-year period. This is the opportunity for doctors to improve their quality of care and relationships with patients. However, this will require staying informed on the latest measurements and penalties enforced by CMS.

Get plentiful knowledge of the tools that need to collect data

 Many EHR and analytics platforms currently do not have the capability to track improvement activities and workflows related to the certification of participating in clinical practice improvement activities. Doctors will need robust platforms to track these activities. All this, to show how they have been able to improve their practice and improve their quality of care. You can get help from external sources as well, which is your medical billing department.

In the End…

With the passage of MACRA, the federal government under the Trump administration has made it clear that the move to value-based care is of great importance. One critical element doctors will need to practice is performance improvement through training and measurement. Those facilities that welcome the value-based payment early and develop a culture of transparency, accountability and obedience to evidence-based guidelines with their establishments stand a good chance of thriving through this transition period.


Medical Billers and Coders

Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.

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