MACRA: Reporting Begins January 2017. Let's Get Ready!

A Change, especially in the world of latest technology and new thought process, is totally inevitable. We are totally aware that the big change of MACRA has petrified most HealthCare providers, and iPatientCare is finding the best way to win with this change. iPatientCare is working hard towards having the best answer about the way MACRA encourages the development of additional payment models or the way it can be implemented.

At iPatientCare, we strive to provide the experts' solution regarding the way an innovative MIPS payment system or the Merit-Based Incentive Payment System can be implemented. Also, one can expect complete solution regarding upgraded reporting system, payment modifications, or improved practicing features.

MIPS, primarily are applicable for physicians of medicine, dentists, osteopathy, and optometry doctors. The MIPS act is also applied to all nursing professionals and certified anesthetists. iPatientCare assimilates MIPS well on how the performance of qualified practitioners can be assessed through value, usage of supply, practice development features, etc.

iPatientCare has a group of accomplished quality consultants to explain about the right ways of addressing the effective ways under MACRA. We will be constantly advising you about all CMS-MACRA updates. Our experts understand about the best ways of implementing the present MACRA regulations.


Medicare Reimbursement Re-Defined with MACRA.

The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) approaches the providers with two different opportunities. The best part is that the providers could grab both the opportunity equally. CMS would reimburse high performance medical groups in an incentivized structure.

  • Opportunity one: Besides giving quality care to your patients, you would also be recognized for giving the same.
  • Opportunity two: You would be able to make an extra incentive for providing the additional quality care.

Quality Payment Program (QPP) offers two roads to reimbursement: Advanced Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS).

MIPS: Your Quality Care Precision Rewarded.

In order to place every provider under the MACRA umbrella comfortably, HHS is looking forward to shift 85% of Medicare providers by 2016 and add more 5% by the end of 2018. Under MIPS, practitioners receive a composite performance score calculated using four weighted performance areas:

  • Quality of care (60%)
  • Resource use (0%)
  • Clinical practice improvement activities (15%)
  • Meaningful use of certified EHR technology (25%)

It is this calculated score that will determine the adjustment that will be made to the Medicare Part B fee schedule beginning in 2019. Performance threshold is determined based on the mean and those below the threshold will receive negative adjustments whereas those above the threshold will receive positive adjustment of 4% in 2019, 5% in 2020, 7% in 2021 and 9% in 2022 and beyond. This adjustment can go as high as 12% in 2019 based on the budget neutrality factor. Clinicians with exceptional performance (which is above the additional performance threshold) will receive additional adjustments ranging from 0.5% upto 10%.

MIPS-composite performance score

APMs-prospective future

APMs: A Prospective Future

Those providers who are qualifying for APM reimbursements include:

  • Accountable care organizations working within the Medicare Shared Savings Program.
  • Organizations adopting the center for Medicare and Medicaid Innovation payment models.
  • Other statutorily-required demonstrations where clinicians accept both risk and reward for providing coordinated, high-quality, efficient care.


There is no urgency to rush; however, be advised that if you start by January 1, 2017, you will be on the fast track to reap bonus revenue in 2019. CMS has laid 4 different paths to MACRA reporting. Every reporting starts with 2017 data and leads to 2019 Medicare Part B base rate adjustments.

Track 1

  • Participation Value: Some or little data throughout the year.
  • Reimbursement: Neutral or Small Payment Adjustments.

Track 2

  • Participation Value: Report for any 90-day period after January 1, 2017.
  • Reimbursement: Small Positive Payment Adjustment.

Track 3

  • Participation Value: Fully participate starting January 1, 2017.
  • Reimbursement: Modest Positive Payment Adjustment.

iPatientCare has been one of the pioneers in the EHR and practice solutions market segment. In fact, iPatientCare is one of the vendors which has an established relationship with CMS and NCQA since 2003! Even before EHR had really become known to the physicians and their office colleagues, the clinical experts and software professionals at iPatientCare were attending meetings with the CMS and NCQA officials to understand and contribute their experience in determining methodologies to capture raw data in EHR and evolve quality indicators or measures which would help determine the quality of care.

Because of its thought-leadership and actual experience of defining what is now known as Quality Program, iPatientCare has been having a group of brilliant consultants/advisors who have been providing their expert advisory and review services to help physician offices on either incident based support, attestation support and active support during MU audits.

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