This October, CMS released the final rule implementing the provisions of the Medicare Access and CHIP Reauthorization Act (MACRA). AGA is reviewing the 2,398-page regulation and will release a summary of key provisions impacting gastroenterologists in the coming weeks.
• When do changes take effect? Services provided beginning on Jan. 1, 2017, will directly impact reimbursement provided in 2019, the first year in which the MIPS program and APMs are effective.
• What should I do right now? AGA’s MACRA resource center (www.gastro.org/MACRA) provides customized advice based on your practice situation.
• What’s next? Over the coming weeks and months, we will provide detailed information and resources to help practices prepare for the upcoming policy and delivery changes.
Join AGA for our upcoming MACRA webinar series to hear from experts about how MACRA will affect you and your practice. Stay tuned for more information about dates and time. Keep reading below for an overview of the final rule and how it will affect your practice.
Final rule overview
• MACRA implementation will not be delayed. The first performance period begins Jan. 1, 2017, which CMS describes as a “transition year.” However, the final rule provides additional details on CMS’ plan to allow physicians to pick their pace of participation under MIPS (see below).
• Merit-based Incentive Programs (MIPS). CMS lowered the cost performance category to 0% in the 2017 transition period and gave clinicians three reporting options under MIPS and one under Advanced Alternative Payment Models (APMs).
• Option one: Report to MIPS for a full 90-day period or full year on quality, clinical performance improvement activities (CPIA), and advancing care (EHR), and maximize the chance to qualify for positive payment adjustments.
• Option two: Report less than a year, but for the full 90-day period on one quality measure, more than one CPIA, or more than the required measures in advancing care information to avoid penalties and receive a possible positive update.
• Option three: Report one quality measure, one CPIA, or report measures of advancing care to avoid penalty.
• Option four: Join an Advanced APM (see below).
Bottom line: If you do not report at least some data in 2017, you will be penalized.
