MACRA is the law that governs the Medicare payment system for providers. Medicare's Quality Payment Program (QPP) is based on MACRA's rules for reimbursements and offers providers two tracks for reporting: MIPS and Advanced APMs. This guide gives an overview of what independent practices need to know.
Plan Your Path
There's no reason for any eligible clinician to pay a penalty to Medicare. Most independent practices will take the MIPS reporting track. Use this MIPS Quick-Start Checklist to see the major milestones for 2019 and get started toward earning positive incentives.
Let Kareo Clinical
Certified EHR Do the Rest
See how much easier it is to report on MIPS measure with Kareo Clinical. Because Kareo's EHR is designed by doctors for doctors, there's no additional data entry for reporting on MIPS measures. You simply chart as usual, and our automated MIPS reporting and tracking system keeps you on track with earning the most in positive adjustments.
Get Higher MIPS Scores and
Earn More With Kareo
With MIPS, you can earn a positive performance-based payment adjustment on Medicare reimbursements based on your reporting score. Kareo helps you document and track progress toward your MIPS goals to make sure you earn more revenue. See how easy we make it:
In Kareo, it's easy to track your performance on quality measures. A simple setup wizard walks you through the steps for selecting measures. Your dashboard displays your progress and even shows you ways to improve your score.
MIPS Promoting Interoperability Dashboard
This dashboard tracks how you're doing in the Medicare Promoting Interoperability (PI) objectives and measures. The dashboard will always reflect the most current information.
Interested in learning more about how Kareo can simplify your MIPS reporting process?
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Frequently Asked Questions
What is MACRA?
MACRA is the Medicare Access and CHIP Reauthorization Act, which is legislation that replaced the Sustainable Growth Rate (SGR). It outlines a new program for physician reimbursement that replaces fee-for-service with value-based payments under the Quality Payment Program (QPP).
What is the Quality Payment Program?
The QPP is the portion of MACRA that defines the new value-based reimbursement system. It has two parts: the Merit-Based Incentive Program (MIPS) and Advanced Alternative Payment Models (APMs). The QPP replaces and consolidates the current Medicare Meaningful Use, PQRS, and value-based modifier programs.
Who Participates in the QPP?
The following provider types must participate in the QPP in either MIPS or APMs:
- Physician (Doctors of Medicine or Osteopathy, Doctors of Dental Surgery or Dental Medicine, Doctors of Podiatric Medicine, Doctors of Optometry, Chiropractors)
- Physician Assistant
- Nurse Practitioner
- Clinical Nurse Specialist
- Certified Registered Nurse Anesthetist
- Physical Therapist
- Occupational Therapist
- Clinical Psychologist
- Qualified speech-language pathologist
- Qualified Audilogists
- Registered dietitians or Nutrition Professionals
Are there exclusions to the eligible provider?
Yes, the following providers are excluded:
- Clinicians who are not one of the clinician types above
- Clinicians who enroll in Medicare for the first time in 2018
- Clinicians who participate in an Advanced APM and are either a Qualifying APM Participant (QP) or Partial QP
- Clinicians who are not in a MIPS eligible specialty
- Clinicians or groups that have billed $90,000 or less in Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries
- Clinicians or groups that have 200 or fewer Medicare Part B FFS beneficiaries
What is an APM?
APMs are CMS's payment approach that gives additional incentive payments to clinicians who provide high-quality and cost efficient care to their patients. These models can apply to a specific clinical condition.
There are different type of APMs:
- MIPS APMs
- Advanced APMs
- Advanced MIPS APMs
- All-Payer/Other-Payer Option
Providers are encouraged to partner up with their APM representative. This could be a local hospital or medical center.
What Are the Requirements for MIPS?
Most providers will participate in MIPS not Advanced APMs in 2017. Under MIPS, providers’ Medicare reimbursements will be adjusted up or down based on how they score across 3 categories:
- Quality (60%) - Replaces the old PQRS system, but is very similar in that it requires providers to report on quality measures.
- Advancing Care Information (25%) - Replaces Medicare Meaningful Use, but is very similar in that it requires providers to use a certified EHR to report measure objectives.
- Improvement Activities (15%) - Practices must attest that they have implemented documentation, workflow, or process improvements.
Do You Need a Certified EHR to participate in the QPP?
Yes, for both MIPS and the Advanced APMs, you need a certified EHR. For 2017 the EHR must be either 2014 or 2015 Edition certified. Starting in 2018, the EHR must be 2015 Edition certified.
How do I find out if my EHR is certified?
Your vendor can tell you if your EHR is 2014 Edition certified to meet the requirements for 2017. However, you should also verify they will be 2015 Edition certified in time for 2018. You can also visit www.healthit.gov and search their list of certified EHRs.
What is the Quality requirement for MIPS?
To meet the Quality requirement for MIPS for most participants, you must report up to six quality measures, including an outcome measure, for a minimum of 90 days. For those using the web interface, you must report 15 quality measures for a full year.
How many measures are there to choose from for Quality?
There are 271 measures to choose from. You can select from those that best fit your practice.
What are the Improvement Activity requirements for MIPS?
For most participants, the requirement for Improvement Activities for MIPS is to attest that you completed up to four improvement activities. For groups with fewer than 15 participants or if you are in a rural or health professional shortage area, the requirements is complete up to two activities for a minimum of 90 days. If you are in a certified patient centered medical home, you automatically get full credit.
How many improvement activities are there to choose from?
There are 93 improvement activities to choose from.
What is the Advancing Care Information requirement for MIPS?
To meet the requirement for Advancing Care Information you need to fulfill these required measures for a minimum of 90 days:
- Security Risk Analysis
- Provide Patient Access
- Send Summary of Care
- Request/Accept Summary of Care
You may also choose to submit up to nine measures for a minimum of 90 days for additional credit. And for bonus credit, you can also:
- Report Public Health and Clinical Data Registry Reporting measures
- Use certified EHR technology to complete certain improvement activities in the improvement activities performance category
Please note that you may not need to submit advancing care information if these measures do not apply to you.
How many measures are there to choose from for Advancing Care Information?
If you are using a 2015 Edition certified EHR you have 15 measures. If you are using a 2014 Edition certified EHR you have 11 measures.
How do we sign up for MACRA?
The MACRA Quality Payment Program has two tracks: MIPS and Advanced APMs. You do not need to sign up for MIPS. You simply report your data during the reporting period. If you are in an Advanced APM you will report through that group. If you do not report at all, you will receive a -4% adjustment in 2019.
How will we report our data for MIPS?
For the 2017 year, MIPS data will be reported via the same methods as the Meaningful Use and PQRS programs. These are claims, registry, QRDC, web interface and/or CMS EHR Incentive Payment Attestation Site. During this first year, providers will most likely need to report via two methods. For example, quality measures can be reported via all methods, except the Attestation Site. Advancing Care may be reported via web interface and the Attestation Web Site, while the Improvement Activities will most likely be reportable via registry and Attestation Site.
Is Medicare Advantage included or does this just apply to Medicare?
This program only applies to Medicare Part B.
If I have been participating in MU, will I continue through 2017 along with MACRA?
No, Medicare Meaningful Use is ending at the end of 2016. If you are participating in the Medicaid MU incentive program, and qualify for MIPS as well, you will participate in both programs.
Are mental health providers eligible clinicians?
Non-physician mental health providers are not currently considered eligible clinicians under MACRA.
Are PTs, OTs, and SLPs eligible clinicians?
PT/OT/SLP providers are not currently considered eligible clinicians MACRA, but they may be added in 2019.
Will there be similar incentives and penalties from commercial payers?
Many commercial payers have already been switching to value-based care programs. Many believe they will follow suit and increase these programs and move more towards value-based programs over the next three to five years.
Do I participate in MACRA if I am doing Medicaid Meaningful Use?
If you also accept Medicare Part B and have more than 100 Medicare patients or bill more than $30,000 in Medicare Part B claims then you would also participate in MACRA.
Is Kareo Clinical 2015 Edition certified?
Yes, Kareo Clinical is 2015 Edition certified.
Currently, I have Kareo Billing and no EHR. What are the next steps to get a certified EHR to participate in MACRA?
You do need a certified EHR to participate in MACRA. There is a possible 7% adjustment on Medicare reimbursement in 2021 based on 2019 performance. So, don’t wait to get a 2015 Edition certified EHR in place so you can participate in 2019. Even minimum participation for 90 days can help you avoid the penalty. You can sign up for Kareo Clinical demo or call 888-775-2736 to speak to a Kareo Solution Consultant now.
Can the required data for MIPS be captured using Kareo Clinical?
Yes, Kareo Clinical provides the fields necessary to capture data for both the Quality and the Promoting Interoperability categories.
Clinicians seeking to report quality measures not supported by Kareo, may still submit any measures in their specialty set when submitted via claims throughout the reporting period.
The late release of the final rule does not give vendors much time to make needed updates to software. Please be patient as we do our best to get you features you need.
Will Kareo provide training on MIPS?
Yes, Kareo offers live training sessions, provides recorded training webinars and training via Kareo University. Additional one-on-one support is available via our paid Professional Services
2015 Edition Certification
This Health IT Module is 2015 Edition compliant and has been certified by an ONC-ACB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services. Vendor name: Kareo, Inc., Product Version: Kareo EHR version 4.0, Date certified: 12/31/17, Drummond Group Inc. Certification No: 15.04.04.2777.Kare.04.00.1.171231, Tested and Certified Modules: 170.315 (a)(1-14); (b)(1-3, 6); (c)(1-3); (d)(1-9); (e)(1-3); (g)(3-9), Tested and Certified Clinical Quality Measures: 2v6; 50v5; 68v6; 75v5; 117v5; 122v5; 123v5; 125v5; 127v5; 128v5; 130v5; 131v5; 135v5; 144v5; 146v5; 147v6; 153v5; 154v5; 155v5; 156v5; 164v5; 165v5; 166v6, Additional Software Required: LabSoft, Updox Direct 2014, Rcopia (DrFirst)
Website: www.kareo.com, Address: 3353 Michelson, Suite 400 Irvine CA 92612, Contact Name: Beth Onofri, Advisor, Healthcare Market, Email: email@example.com, Phone: 949-509-2472.
Any additional types of costs that an EP, EH, or CAH would pay to implement the Complete EHR’s or Health IT Module’s capabilities in order to attempt to meet meaningful use objectives and measures. Developers must also include any material product technical or contractual limitations. Refer to the Drummond Group Mandatory Disclosure Statement document for more details. EHR technology self-developers are excluded from this requirement.
Cost and Limitations
The monthly subscription fee for Kareo Clinical (Kareo EHR v. 4.0) includes all tested and certified modules listed above with exception of a one-time small set-up for implementation of e-prescribing of controlled substances. For a detailed explanation of costs and limitations, click here. For information on Kareo’s patient API, click here. Optional services, which are not required for CMS Incentive Programs, are available for a nominal fee. These services include custom template development and private CMS Incentive Programs coaching.