MACRA Releases Final Rule for 2018 Performance

CMS has issued the final rule for 2018 for the Quality Payment Program (QPP). The QPP program is in the second year of implementation continually trying to adjust the QPP to become more comprehensive and offer better incentives for the providers.

Changes in MACRA will be affecting the reimbursement for the providers here are some things to look for in Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (AAPM).

A thorough analysis of the MACRA 1,653 pages rulebook we have created chosen the rules which will affect your billing to the maximum.

Merit-based Incentive Payment Model (MIPS)

  1. CMS has added leniency for providers affected by natural disasters e.g.:- Fire, Hurricane

For the 2018 rule, CMS has made provisions for uncontrollable circumstances of natural disasters and health emergencies to submit hardship exception applications. This would mean that the CMS would reconsider the advancing-care information for 2017 and for the quality, cost, and improvement for 2018. CMS has also exempted many clinicians for quality, improvement and cost categories in 2017.  The final rule for the following will not take effect from 2018.

  1. For 2017 the final score which would depend on the quality-60 percent, improvement activities-15 percent, cost- 0 percent and for the advancing care-25 percent. For 2018 the performance for 2018 is the quality- 50 percent, Advance care information- 25 percent, cost-10 percent, and improvement activities-15 percent.
  1. Bonus Opportunities for providers

Small practices that have 15 or less number of physicians can also 5 additional points if they submit on one performance category. Physicians can also earn up to five more points for treating complex patients. For all patients eligible for Medicare and Medicaid insurance.

  1. The threshold for revenue and patient raised

In 2017, if providers have billed less than $30,000 for Medicare Part B or treated less than 100 patients who are beneficiaries of Medicare Part B. In 2018, the bare is promoted to $90,000 and 200 patients annually. Individual physicians or physicians of less than a group of 10 can band together to report the MIPS parameters.


Extended Advanced APM by two years

This says that at least 8 percent of physician’s revenue has to be in risk to qualify for the extension of performance for the year 2020. The performance standard will be extended till 2020, this rule applies to the physicians under the financial risk and who are APM under the non-Medicare payers can also qualify for the Advanced APM.

The rulebook also provides information on the All-payer combination model which will be available by 2019. This will include the determination and data submission for the model which will allow the physicians to qualify for the Advanced APM.

The CMS rules have had a mixed reception, while some providers have lauded CMS and others say that it could have been better under the new regulations. Some of the physicians supported saying that the administration has continued providing the flexibility for the participation of providers. However, some of the feel that the CMS has shied away from the value-based just to maintain the equilibrium for the providers.

It seems like the CMS wants to ease out the process of value-based payment model for the providers before fully plunging into the model. This will provide with a breather for the individual physicians and small practices. While in later years how the practices would be taking the leap for value-based care would be an interesting factor to see.

While ASC and emergency service providers feel left out with non-expected departments where the 10 points where cut-down bringing it from 50 percent to 40 percent.

For more information on the effects of MACRA rule on your practice contact us through our medical billing and coding specialist.