John Lynn Answers Your MACRA Questions

As a follow up to our webinar, MACRA: What’s In Store for Independent Practices, John Lynn and Kareo have answered the questions posed by attendees.  Here are the responses to some of the more common questions about MACRA. Tweet this Kareo story



Q: Where can we find more information on MACRA?
A: The best place to start is with the CMS. They have a page setup for MACRA.

Q: Where can we find the small practice information from CMS?
A: Here is the link to the Small Practice Fact Sheet. Also, consider reaching out to your local REC to see if they’ll be accessing the $20 million per year that CMS will be paying to organizations that support MACRA and APM participation by small practices.

Q: If MU and PQRS continue until 2018 and MACRA starts in 2017, how do they overlap?
A: MU and PQRS are being paid through 2018 for eligible providers. The payments for MACRA seamlessly begin in 2019 as the MU and PQRS programs end. However, the data you collect in 2017 will be used by CMS to determine what payment adjustments you’ll be eligible for in 2019. What’s not clear is what will happen to MU and PQRS if CMS decides to delay MACRA for a year.

Q: Does your EHR have to be certified to participate in MIPS or Advanced APMs?
A: Yes, it needs to be a certified EHR similar to how it had to be a certified EHR for the Medicare EHR incentive program (Meaningful Use).

Q: If I am planning to retire in the next 3-5 years, is it really worth it to participate in MACRA?
A: You’ll need to run the numbers to decide if it makes sense for you to participate. It will depend on how many Medicare patients you serve and what the impact of the penalties may be. Also consider whether or not you might want to sell your practice. If that is a consideration then you might want to prepare your practice to be successful through the long term.

Q: If you have not participated in MU or PQRS yet, do you start with MIPS in 2017?
A: Yes, you would begin with the measures as laid out for MIPS in 2017 unless you’re part of a Qualified APM or meet one of the other MIPS exclusions.

Q: Are there exclusions for providers who spend 50% or more of their time at a hospital or nursing facility like there was for MU?
A: There are three proposed exempted clinicians:

  1. Those who are newly enrolled in Medicare;
  2. Those who have less than or equal to $10,000 in Medicare charges and less than or equal to 100 Medicare patients;
  3. Those who are significantly participating in an Advanced Alternative Payment Model (APM)>

It is proposed that all remaining clinicians will be participating in MIPS.

Each component of the MIPS program will have its own exclusions/exceptions. It is proposed that that these were remain similar to the programs from which they are derived. With the current programs, hospitalists would have an exclusion for the Advancing Care component because they had one for the MU component. Their PQRS measures would be limited to the few that they are eligible to report. Their score is adjusted based on these exclusions/exceptions.

It appears that this exclusion is one of the areas that will not be decided for sure until CMS receives more public comment. This means we will not have a definitive answer until October or November.

Q: If we are doing Medicaid MU do we still do MIPS?
A: No, if you are doing Medicaid MU you stay the course you are on. However, there’s some talk that similar requirements could be made to the Medicaid program in the future. So, it’s good to keep a casual eye on what’s happening with MIPS.

If you missed John's MACRA webinar, watch the recording with the full question and answer period now.


About the Author

John Lynn is the Editor and Founder of the nationally renowned blog, the leading healthcare IT job, and the...

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