The Medicare Access and CHIP Reauthorization Act (MACRA)
On January 1, 2017, physicians, providers, and health care providers will embark on the era of MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, which will dramatically change how providers are paid by the Centers for Medicare and Medicaid Services. Signed into federal law by President Obama on April 16, 2015, MACRA is a fix for the unsustainable Sustainable Growth Rate (SGR) formula.
On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) published its final rule on of the Quality Payment Program (QPP) creating a flexible system for physicians and other eligible providers to select between two paths connecting quality to payments. This creates a provider payment system more in line with how healthcare is approached today versus 20 years ago. The QPP pathways seek to tie an increased percentage of physicians’ Medicare fee-for-service (FFS) payments to outcomes through the new Merit-based Incentive Payment System (MIPS) and to encourage the adoption of “alternative payment models” (APMs) which will require practices to take on more financial and technological risks. According to the MACRA rules, providers will be able to switch between the MIPS and the APM track on a year-to-year basis.
On September 8, 2016, Acting CMS Administrator Andy Slavitt acknowledged the concerns and trepidation of meeting reporting requirements by announcing 2 additional 2017 data submission options to give providers additional time to submit Quality Payment Program data. With a total of four reporting options, providers can choose to submit data for the entire year, they can submit data for a part of the year, they can submit any data before the end of the year, or they can decline to submit any data during 2017. Each choice will be accompanied by positive or negative payment adjustment.
Report One Sleep-Specific Quality Measure and Avoid a Penalty in 2019
The Merit-based Incentive Payment System (MIPS) of the Quality Payment Program is already underway. MIPS participants who did not start their activities by October 2, 2017 are no longer eligible for a positive payment adjustment in 2019. However, MIPS-eligible clinicians can still avoid a 4% penalty by reporting one quality measure for one patient. Clinicians have the option to report on any one quality measure, but the steps below outline the process you need to follow to report any of the four sleep-specific quality measures.
- Complete lines 1-20 of the CMS 1500 form as you normally would.
- Complete line 21 by entering the appropriate ICD-10 code for the appropriate diagnosis or nature of illness or injury.
- Review the Quality Measure Specifications document for the sleep-specific measure you will be using:
- Review the numerator quality data coding options and choose the appropriate scenario and associated code. Enter the Quality Data Code (QDC) in 24D along with codes for all other procedures, services or supplies associated with the service.
- In 24F, list the charges associated with each code. List a line-item charge of one cent ($0.01) for the QDC entered in 24D. Failure to enter this $0.01 charge may lead your carrier to reject the claim.
- Finish entering information in boxes 25-33.
- Submit your 1500 form to your Medicare Administrative Contractor (MAC). The activity associated with the claim must have been completed by December 31, 2017. The claim must be submitted to your MAC by February 28, 2018. Note: It is recommended that clinicians submit more than 1 claim for the chosen measure(s) to be sure to avoid a penalty in 2019.