Making Sense of MIPS/MACRA for 2021

Celebrating the 5-year anniversary of implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) program is making some changes that providers need to understand to maximize their compensation opportunities. Despite the difficulties of running a practice during the COVID-19 pandemic, the rules have gotten stricter.

Because MACRA has raised the bar, it has become harder than ever to meet the requirements, avoid a penalty adjustment and earn a financial reward. The deadline for attestation – when doctors need to submit reports on everything they worked on last year and earn enough points to achieve neutral or better status – is March 31.

As most providers know, MACRA is the government’s value-based reimbursement program, which provides incentives to physicians for the quality of their work. Its methodology focuses on payment models that are designed to reward clinicians for value over volume. Physicians score points on quality outcomes such as documentation of medications, controlled blood pressure or controlled hemoglobin. Providers have options to report as individuals or groups, and practices of 15 physicians or more can aggregate their data. In any case, physicians must report on objectives and measures taken to meet them.

MACRA requires that the providers meet various criteria, submit data, and get positive, negative, or neutral payments based on the outcomes. There are four Merit Based Incentive Payments System (MIPS) categories – cost (20%), quality (40%), improvement activities (15%) and promoting interoperability (25%) – for providers of professional services paid under Medicare Part B.

While many healthcare professionals have not made this reporting task a priority, physicians can no longer afford to do the bare minimum to avoid a financial penalty adjustment. The bar has been raised for the 2021 reporting year with the minimum point requirement now at 60 points, up from 45 last year, and Kareo wants to help providers get the best return.

In a free, live webinar, “The MACRA Bar Has Been Raised: Don’t Give Your Money Away,” slated for Wednesday, February 17, at 1 PM ET | 10 AM PT, Marina Verdara, a Health Reform Subject Matter Expert, will provide an overview of MACRA and what has changed over the past year. In addition, she will:
  • break down the four MIPS reporting categories, including requirements for each and how you can meet them
  • walk billers and billing companies through the claims submission process
  • share best practices to avoid a negative payment adjustment.

Verdara, who has more than nine years of experience working directly with hundreds of small practice clinicians on a variety of projects, specializes in guiding Kareo customers to higher levels of success with their CMS Incentive Program reporting.

“Medicare keeps raising the bar, so thresholds are increasing,” Verdara explained. “There are incentives to earn points, but there are fewer options for earning bonus points. It’s harder than ever to meet the requirements to avoid a penalty and earn a financial reward.“

She added, “We’ll be providing updates on what is expected – how to maximize scores, earn incentives and reduce penalties. We’ll offer a heads-up of what’s coming, and we’ll focus on best practices. For instance, document as each measure indicates, don’t ignore the Cost and Interoperability categories, know how to earn the easy points and learn how to avoid penalties.”

Verdara explained that the COVID-19 pandemic impacted many practices. For example, there have been fewer patients going for their annual checkups and preventative care visits Outcomes for MACRA reporting are affected when patients avoid going to the doctor. She added that providers may need to start their care plans “from scratch,” especially in senior populations.

“This is such a difficult year to avoid penalties, so people need to stay on top of the changes by attending webinars and reading blogs,” Verdara said. “MACRA is not an easy ’language’ to retain, but when providers keep hearing it, they understand that they have to raise the bar themselves.”

On a positive note, the amount of money available to fund positive payment adjustments under MACRA will increase significantly, year after year. Providers who learn how to maximize a practice’s MIPS performance will begin to see significant positive financial incentives.

If you are ready to learn about how you can maximize your financial rewards and avoid paying penalties under MACRA, be sure to attend Kareo’s upcoming webinar on Wednesday, February 17. To register for “The MACRA Bar Has Been Raised: Don’t Give Your Money Away,” click here: 

About the Author

Ilene Schneider, owner of Schneider the Writer, provides communications support to health care, technology, educational and service enterprises. Ilene has an extensive...

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