Michigan State Medical Society > Resources > Billing and Coding > Medicare Access and CHIP Reauthorization Act (MACRA)

Overview

Medicare’s shift to value-based payment has been occurring incrementally over the past several years. Initiatives incorporating a “carrot and stick” approach to quality reporting such as the electronic prescribing, physician quality reporting system (PQRS), meaningful use (MU), and the value-based payment modifier (VBPM) are all precursors to Medicare’s latest and most transparent effort shift from volume to value.

When Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in April 2015 most of the attention was on the repeal of the sustainable growth rate (SGR). However, MACRA provided the opportunity to further goals set by the U.S. Department of Health and Human Services (HHS) to link traditional, or fee-for-service, Medicare payments to value-based outcomes. By 2018, HHS would like to see 50 percent of Medicare payments tied to some type of alternative payment model such as Accountable Care Organizations (ACOs) or bundled payment and 90 percent of all traditional Medicare payments tied to quality or value.

This new Medicare payment structure is being called the Quality Payment Program (QPP). The QPP establishes two new payment pathways for physicians. The first pathway is a modified fee-for-service model that combines and streamlines existing Medicare quality reporting programs (PQRS, MU, and VBPM). This pathway is referred to as the Merit-Based Incentive Program (MIPS). MIPS replaces the multiple payment adjustment methodologies under these various programs with one payment adjustment structure that will measure physicians and other eligible clinicians based on performance in four categories:

Quality
Resource Use
Advancing Care Information
Clinical Practice Improvement Activities

The second pathway provides a fixed five percent annual bonus payment to physicians participating in value-based alternative payment models (APMs) that focus on reduced costs and high-value services. This is referred to as the Advanced APM pathway.

Payment adjustments pursuant to the QPP are scheduled to begin on January 1, 2019. However, as with other Medicare quality programs, there is a two-year look back for the data on which those payments will be computed. So, the actions taken by physicians in 2017 (performance year) will determine their Medicare payments in 2019 (payment adjustment year).

For the 2017 performance year, physicians and other eligible professionals have several options for participation to avoid a negative payment adjustment in 2019. CMS refers to the options below as “Pick Your Pace.”

First Option
- Test the QPP by submitting minimal data to ensure that your system is working and that you’re preparing for broader participation in 2018 and 2019.
Second Option
- Participate in the QPP for a portion of the 2017 performance period versus the full period. By choosing this option, you could qualify for a small positive payment adjustment.
Third Option
- Participate in the QPP for the entire 2017 performance period by submitting information for the entire year on quality measures, how your practices uses technology, and what improvement activities your practice is undertaking.
Fourth Option
- Participate in the QPP by joining an Advanced APM and if you meet the thresholds for Medicare payments or number of Medicare patients, you can earn the five percent payment initiative in 2019.

Physicians and other eligible clinicians choosing not to participate in any of the above options in 2017 will receive a four percent penalty in 2019.

MACRA Webinar Series

Key Things You Should Know About MACRA

Key Things You Should Know About MACRA

Presenter:
Leland Babitch, MD, President and CEO, MPRO

Cost:
$50 MSMS Member Physicians & Office Staff
$75 Non-Member Physicians

Earns: .5 CME credits

Duration: 30 minutes

Why MACRA? A background on the development of MACRA is discussed along with a "10,000 foot view" of the Quality Payment Program.

On-Demand Webinar - Register Now

To receive credit, an evaluation must be completed in its entirety. Evaluations are located at the end of each module.

Disclosures:
Leland Babitch, MD, does not have relevant financial relationships.
The MSMS meeting planners (Beth Elliott and Caryl Markzon) do not have relevant financial relationships.

Statement of Accreditation: The Michigan State Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

AMA Credit Designation Statement: The Michigan State Medical Society designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Roadmap for Getting Started

Roadmap for Getting Started

Presenter:
Holly Standhart, Senior Clinical Quality Consultant
Lake Superior Quality Innovation Network

Cost:
$50 MSMS Member Physicians & Office Staff
$75 Non-Member Physicians

Earns: .75 CME credits

Duration: 45 minutes

This webinar will include information on necessary technology, documentation and activities needed to be successful, information on the "Pick Your Pace" option and important resources and tools to use to your advantage.

On-Demand Webinar - Register Now

To receive credit, an evaluation must be completed in its entirety. Evaluations are located at the end of each module.

Disclosures:
Holly Standhardt does not have relevant financial relationships.
The MSMS meeting planners (Beth Elliott and Caryl Markzon) do not have relevant financial relationships.

Statement of Accreditation: The Michigan State Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

AMA Credit Designation Statement: The Michigan State Medical Society designates this enduring material for a maximum of .75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

MACRA: Alignment Strategy

MACRA: Alignment Strategy

Presenter:
Stacey Hettiger, Director, Medical and Regulatory Policy
Michigan State Medical Society

Cost:
$50 MSMS Member Physicians & Office Staff
$75 Non-Member Physicians

Earns: .5 CME credits

Duration: 30 minutes

Participants will understand Medicare's shift from traditional fee-for-service reimbursement to payments tied to value-based outcomes identifying the key changes, identify opportunities to earn enhanced payments and knowledge about key resources.

On-Demand Webinar - Register Now

To receive credit, an evaluation must be completed in its entirety. Evaluations are located at the end of each module.

Disclosures:
Stacey Hettiger does not have relevant financial relationships.
The MSMS meeting planners (Beth Elliott and Caryl Markzon) do not have relevant financial relationships.

Statement of Accreditation: The Michigan State Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

AMA Credit Designation Statement: The Michigan State Medical Society designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The Role of Documentation

The Role of Documentation

Presenter:
Jill Young, CPC, CEDC, CIMC
Young Medical Consulting

Cost:
$50 MSMS Member Physicians & Office Staff
$75 Non-Member Physicians

Earns: .5 CME credits

Duration: 30 minutes

The more precise and thorough the documentation; the better chance for payment adjustments. This webinar will provided tips on how to accurately and completely document the delivery of patient care.

On-Demand Webinar - Register Now

To receive credit, an evaluation must be completed in its entirety. Evaluations are located at the end of each module.

Disclosures:
Jill Young does not have relevant financial relationships.
The MSMS meeting planners (Beth Elliott and Caryl Markzon) do not have relevant financial relationships.

Statement of Accreditation: The Michigan State Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

AMA Credit Designation Statement: The Michigan State Medical Society designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Technology Survival Tips to Tackle MACRA

Technology Survival Tips to Tackle MACRA

Presenter:
Dara Barrera, Manager, Practice Management & Health Information Technology
Michigan State Medical Society

Cost:
$50 MSMS Member Physicians & Office Staff
$75 Non-Member Physicians

Earns: .5 CME credits

Duration: 30 minutes

EHR use is at the core of the Quality Improvement Program. Included in this webinar is information on what Advance Care Information is, who is eligible, reporting options, scoring and measures.

On-Demand Webinar - Register Now

To receive credit, an evaluation must be completed in its entirety. Evaluations are located at the end of each module.

Disclosures:
Dara Barrera does not have relevant financial relationships.
The MSMS meeting planners (Beth Elliott and Caryl Markzon) do not have relevant financial relationships.

Statement of Accreditation: The Michigan State Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

AMA Credit Designation Statement: The Michigan State Medical Society designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Using a QCDR as the Path to Change

Using a QCDR as the Path to Change

Presenter:
Thomas Dent, MD, President and Medical Director
Roji Health

Cost:
$50 MSMS Member Physicians & Office Staff
$75 Non-Member Physicians

Earns: .5 CME credits

Duration: 30 minutes

A Qualified Clinical Data Registry (QCDR) is a specialized tool to measure and improve performance. This webinar will provide detailed information on what a QCDR is, how it's used and the advantages it provides.

On-Demand Webinar - Register Now

To receive credit, an evaluation must be completed in its entirety. Evaluations are located at the end of each module.

Disclosures:
Thomas Dent, MD, is the Medical Director and President of Roji Health Intelligence. His presentation has been peer reviewed and no conflicts exist.
The MSMS meeting planners (Beth Elliott and Caryl Markzon) do not have relevant financial relationships.

Statement of Accreditation: The Michigan State Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

AMA Credit Designation Statement: The Michigan State Medical Society designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Navigating Need to Know Resources

Navigating Need to Know Resources

Presenter:
Stacey Hettiger, Director, Medical and Regulatory Policy
Michigan State Medical Society

Cost:
$50 MSMS Member Physicians & Office Staff
$75 Non-Member Physicians

Earns: .5 CME credits

Duration: 30 minutes

Awareness of the components and criteria of MACRA's Merit-based Incentives payment system (MIPS), alignment opportunities to maximize success under MIPS and options and strategies for participation will be shared.

On-Demand Webinar - Register Now

To receive credit, an evaluation must be completed in its entirety. Evaluations are located at the end of each module.

Disclosures:
Stacey Hettiger does not have relevant financial relationships.
The MSMS meeting planners (Beth Elliott and Caryl Markzon) do not have relevant financial relationships.

Statement of Accreditation: The Michigan State Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

AMA Credit Designation Statement: The Michigan State Medical Society designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

MACRA - Really? The Reasons Why

MACRA - Really? The Reasons Why

Presenter:
Greg Forzley, MD, FAAFP

Cost:
$50 MSMS Member Physicians & Office Staff
$75 Non-Member Physicians

Earns: .75 CME credits

Duration: 45 minutes

Description.

On-Demand Webinar - Register Now

To receive credit, an evaluation must be completed in its entirety. Evaluations are located at the end of each module.

Disclosures:
Greg Forzley, MD, FAAFP does not have relevant financial relationships.
The MSMS meeting planners (Beth Elliott and Caryl Markzon) do not have relevant financial relationships.

Statement of Accreditation: The Michigan State Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

AMA Credit Designation Statement: The Michigan State Medical Society designates this enduring material for a maximum of .75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.