How MACRA Could Affect Your Revenue Cycle

Blog since updated to reflect: The Medicare final rule on MACRA, was released on October 14, 2016. To ease the burden to Small, Rural and Health Professional Shortage Areas (HPSA), the established low-volume threshold was adjusted (replacing the proposed low-volume threshold).  The final established low-volume threshold is now less than or equal to $30,000 in Medicare Part B allowed charges or less than or equal to 100 Medicare patients.

 Medicare-Access-CHIP-Reauthorization-Act

As you may have heard, the permanent doc fix is here, in the form of MACRA - Medicare Access & CHIP Reauthorization Act. 

The new legislation, among other actions, accentuates quality by:

  • replacing a quilt work of existing programs,
  • adding one additional category, Clinical Practice Improvement Activities (CPIA),
  • and placing all programs under one Quality Payment Program umbrella.

Introduced under the legislation are two models under which physician payments will change: Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Models. I will outline and explore those changes in even more depth in an upcoming post.

Most clinicians will be subject to MIPS, at least initially. Under either model, favorable or severely unfavorable payment adjustments may take place that may disrupt cash flow, beginning in 2019.

The groups of clinicians, not participating in MIPS are:

  • Eligible clinicians within the first year of Medicare Part B participation
  • Certain participants in an advanced Alternative Payment Model
  • Physical/Occupational therapists, Speech/language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, and dieticians/nutritional professional are excluded for at least years one and two of the program

Hospital or facilities, including clinicians that bill under Rural Health Clinics (both Provider based and most likely Independent Rural Health Clinics), are exempt.

 Kerry-Luciani-Business-Intelligence-Manager-HRG

Kerry Luciani


BUSINESS INTELLIGENCE MANAGER FOR HEALTHCARE RESOURCE GROUP, INC. 

Kerry has over 30 years of healthcare revenue cycle management experience on both the payer and provider side. Over the course of his career, Kerry has developed an abundance of expertise in Medicare Part B reimbursement and has published several comments in the Federal Register.

have additional questions on how MACRA may affect you or your revenue cycle?