Understanding MACRA, QPP and MIPS in 5 Minutes or Less
Let’s Start With Definitions:
MACRA – the law that authorized CMS to create QPP and its requirements.
QPP – the “Quality Payment Program” – a program created by CMS to reward or penalize medical practices for engaging or failing to engage in certain desired behaviors
MIPS – Merit-based Incentive Payment System – the most common way for doctors to participate in QPP
What it means for Doctors? – You should submit certain information to Medicare during 2021. Your penalty or bonus is based on how much of the information you submit.
• Submit the information – your Medicare payments in 2023 will increase by up to 9%
• Fail to submit the information – your Medicare payments in 2023 will decrease by up to 9%
What information must you submit? There are 3 categories of information to submit:
• Quality Measures – Evidence showing that you are evaluating patients for certain conditions and behaviors
o Example: Evaluate patients for primary open-angle glaucoma (“POAG”)
• Promoting Interoperability (previously called “Advancing Care Information”) – Evidence showing that you use certain “best practices” in your medical practice
o Example: Communicate with at least one patient using a secure messaging platform
*Note: You need a certified EHR system to comply with this category (you don’t need one for the other categories)
• Improvement Activities – Evidence showing that you engaged in certain activities around care coordination, patient engagement and patient safety
o Example: Identify patients at risk for falls through fall screening and assessment programs
*Note: A fourth category - Cost - is also part of the final practice score, but it is calculated automatically by Medicare. No special actions or submissions by physicians are required.
How should you submit the information?
• Quality Measures – Include certain CPT codes on claims
o Example: You evaluated a patient for primary open-angle glaucoma? Submit code 2027F with a charge amount of $0.01 on her claim.
• Promoting Interoperability - Your EMR system should be able to submit this information. If it can’t, you can submit the information manually at qpp.cms.gov/login.
• Improvement Activities – Create a log-in at qpp.cms.gov/login and manually enter your data.
Do all these QPP requirements apply to you?
While there are some exceptions to the participation requirement - for example, if you bill less than $90,000/year in Medicare claims and meet certain other requirements - most practices are required to participate. Check your participation requirements at https://qpp.cms.gov/participation-lookup
Where can I get more information?
• https://qpp.cms.gov; or
• Call us at 301-591-3878 and we’d be happy to answer any of your questions.
Rusty Wilson is the founder and principal of eMed Partners, a full-service medical billing company for physicians and medical practices.
For more about our billing services: http://emedpartners.com/
To follow Rusty on LinkedIn: https://www.linkedin.com/in/rusty-wilson-520206/