Do You Know Your MACRA Participation Status?

August 21st, 2017 -
Vinay Deshpande
/ 4 Min Read

Summer is almost gone, and we’re getting closer to the Oct. 2nd deadline to collect quality reporting data under the Medicare Access and CHIP Reauthorization Act (MACRA). The level to which you participate this year determines what your payment adjustment will be in 2018. Our number one piece of MACRA advice: avoid negative payment adjustments.

A good starting point is to visit the CMS Quality Payment Program page and enter your National Physician Identifier (NPI) to check your status. We urge all PrognoCIS physicians to learn what their MACRA status is and notify your PrognoCIS representative and contact us in order to get the proper training for how to collect quality data.

Now, you may have several MACRA-related questions that that remain unanswered, such as the following: How do I collect quality data? Am I required to participate in MACRA or Meaningful Use—or both? Does my Electronic Health Records (EHR) software have the right certifications from the Office of the National Coordinator for Health Information Technology (ONC)?

Let’s take some time for a brief overview of these programs from The Centers for Medicare and Medicaid Services to more fully understand what to expect and how to participate.

Understanding MACRA, and the Quality Payment Program

The Quality Payment Program (QPP) is the part of MACRA that applies to Medicare. Participation in this program, and therefore in MACRA, depends upon the amount of Medicare services your practice provided during the year 2017. If you saw at least 100 Medicare patients during that time, you qualify for participation in the QPP. The other way to qualify is if during 2017, your practice submitted at least $30,000 in claims to Medicare. If you qualify, you must submit data by March 2018.

This program contains three submission categories: Quality (also called the Physician Quality Reporting System, or PQRS), Advancing Care Information (ACI) and Improvement Activities (or value-based modifier). Providers are expected to report on each of these categories, and they are weighted as follows:

  • Quality: 60%
  • ACI: 25%
  • Improvement Activities: 15%

CMS places emphasis on how much data you collect, and how meaningful that data is. Submitters are scored based on benchmarks of quality reporting data. Your score out of 100% determines what your reimbursement will be. The highest possible payment adjustment is +4% (earned by meeting all reporting and quality requirements), and the lowest is -4% (no participation). In order to meet the minimum participation requirements and avoid any payment adjustment, you can submit a test, which is the minimum amount of 2017 data. You can collect data and submit for just one quality measure, or improvement activity, for any period during 2017.

What About Reporting For Meaningful Use?

Meaningful Use (MU) was the predecessor to MACRA, and many physicians will still participate in it this year for Modified Stage 2, or Stage 3. This year, Medicare has been taken out of the MU program, and only Medicaid providers will participate. The parts of MU that previously dealt with Medicare are what comprise the ACI portion of the QPP. 2015 ONC certification is required for MU reporting.

Is Your Practice Ready to Collect QPP Measures?

Many EHR systems do not have 2015 ONC certification, which is why the CMS considers 2017 a “trial” year, with more flexible rules. The original requirement was to collect quality data for the entire 2017 year, but that has been reduced to a minimum of 90 days—hence the deadline of October 2nd, 90 days before the end of the year. The period to submit the data collected for 2017 will be from January 1 through March 31, 2018.

Interestingly, there are few, somewhere between 15-30, MACRA-certified EHRs on the market today. Because the rules are more relaxed, doctors can continue to use 2014-certified EHRs. Starting January 1st, however, clinicians are required to use 2015-certified products.

How to Collect Your Quality Data With PrognoCIS EHR

Practitioners who use PrognoCIS EHR Software in their practice can collect quality data from each category under the QPP in order to avoid receiving a negative payment adjustment. We suggest you visit the QPP website and determine what your reporting requirements are (i.e., are you required to submit as an individual? As a group? Are you required to submit once? Twice? Do you serve Medicare or Medicaid patients?).

Once you know what your reporting requirements are for 2017, please contact us, and we can begin to conduct training with you and your practice. Because so many of the requirements this year are different, proper training is your key to success in order to be ready to collect data by October 2nd.

We are ready to help you and your practice collect quality data, meet reporting requirements, and avoid any negative payment adjustment from the CMS for the year.

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