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What Physicians Should Know About MACRA in 2019

By Tim Callahan08 May 2019

MACRA-physiciansIf you’re feeling burned out by the arduous, time-consuming requirements set forth by the Centers for Medicare and Medicaid Services (CMS) governing physician payments, you’ll be happy to know the agency has made several changes to simplify and improve the Quality Payment Program (QPP) process.After considering extensive feedback from the medical community, CMS released its final rule for its Medicare Quality Payment Program in 2019, under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

You can read the full CY 2019 Quality Payment Program final rule text here, but we’ve broken down five key MACRA 2019 changes physicians need to know:


1. CMS has added a third low-volume threshold for exemptions

To be exempt from QPP, clinicians or groups must meet at least one of the following:

  • Provide care for 200 or fewer Medicare beneficiaries
  • Provide $90,000 or less in Medicare Part B charges (for covered professional services)
  • Provide 200 or fewer covered professional services (under the Physician Fee Schedule)*

*This is the new low-volume threshold.

If you do not meet any of these criteria, you must report under the Merit-based Incentive Payment System (MIPS) or face a penalty.

2. MIPS received a few much-needed updates

Here are three of the most notable MIPS updates:

  • MIPS category percentages have shifted: The quality category has dropped from 50 percent of the final MIPS score to 45 percent, and the cost category has increased to 15 percent. Quality reporting requirements have not changed much from 2018, and clinicians will still be required to report six quality measures (including at least one outcome or high-priority measure). CMS also removed 26 quality measures and added eight new ones.
  • Physicians can choose to opt-in to MIPS: If a clinician or group meets one or two of the low-volume threshold requirements to be exempt from QPP — but not all three — they can choose to opt-in to MIPS. It’s important to note that choosing to opt in means being subject to neutral, negative or positive performance-based payment adjustments, and this decision cannot be reversed.
  • More clinicians types are eligible for MIPS: MIPS eligibility now includes several new clinician types (including physical therapists, occupational therapists, speech-language pathologists, audiologists, clinical psychologists and registered dietician or nutrition professionals).

3. All physicians must have EHRs

The 2019 final rule requires all physicians to use the 2015 Certified EHR Technology (CEHRT) in the 2019 reporting year. Last year, CMS allowed physicians to continue using the 2014 edition technology but has now determined this is no longer acceptable. According to CMS, requiring physicians to use more advanced EHR tech will help improve interoperability.

4. New benefits for small practices and treating complex patients

Small practices (those with 15 or fewer eligible clinicians) will receive a point bonus to 2019 scores. Unlike in previous years, this will be included as part of the quality performance category rather than as a standalone item. If a clinician submits data on one or more quality measures, the bonus will increase to six points. Small practices will also receive three bonus points for any quality performance measures that don’t meet requirements for a full patient panel.

Additionally, after many clinicians and groups shared concerns that treating complex patients would lower their quality score, the CMS will award five bonus points (as part of the MIPS program) for those providing care to complex patients.

5. Higher payment adjustments

In 2021, payment adjustments will range from -7 percent to 7 percent and, because the program is budget neutral, positive payment adjustments will be multiplied on a scaling factor. The maximum positive adjustment will likely be less than 7 percent.

Keeping up with MACRA changes can be challenging, but staying aware of updates can help you streamline your workflow and make the necessary preparations. Thanks to feedback from other physicians, these updates should improve your collections, increase reimbursement opportunities and support your practice in providing the best quality of care to your patients in 2019 and beyond.

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