Major Changes Coming to Physician Reimbursement
Everyone has been working toward the October 1 ICD-10 transition deadline (and congrats because it looks like everything has gone well so far), but there is something on the horizon that is just as major to the medical industry.
Passed this spring, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the Sustainable Growth Rate (SGR) formula and replaced it with something called the Merit-based Incentive Payment System (MIPS).
Healthcents has been doing extensive research in this area, and we want to alert you about the important coming changes to physician reimbursement. (This is such a major topic that we have been asked to address it at next month’s Practice Management Institute’s National Conference for Medical Office Professionals.)
Here is how MACRA is changing the Medicare reimbursement rules:
- From 2015 to 2019, there will be automatic .5% increases on Medicare physician fee schedule
- From 2019 to 2025, reimbursement remains flat unless you are participating in MIPS or APM (an alternative payment model)
So MIPS represents a bit of a gamble — remain flat on your Medicare physician reimbursement or take a chance to earn more (or have your payments decreased).
How MIPS works is that eligible practitioners are given a score on a scale of 0-100, which affects their Medicare reimbursements. This calculation takes into account four main areas: quality (measures from PQRS, EHR MU, QCDRs), resource use (measures from VM and episodes of care), meaningful use of an EHR system, and something that is called clinical practice improvement activities.
Once calculated, your MIPS score could affect Medicare physician reimbursement anywhere from -4% to +4%. That’s a major impact to your bottom line, considering almost half of each practice’s revenue comes from public payer programs.
The good news is that these policies are not fully defined or set in stone … yet. The CMS is holding a comment period for MIPS until Nov. 2.
You can read the full proposal and submit your comments by clicking here.
The phrase “make your voice heard” get thrown around a lot, but this is definitely something worth your time to read and comment on.