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How MACRA, MIPS Affect Your Physician Services MESSAGE FROM THE PRESIDENT


I


n the last few months, some of you might have received a letter from the Centers for Medicare & Medicaid Services (CMS) talking about Medicare’s new Quality


Payment Program. This program is part of a large-scale shift in the way Medicare pays physicians and other clinicians since Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015. While the program has many nuances, I hope I can provide some clear starting points here as we work through this new system together in the coming months and years. MACRA’s Quality Payment Program is the new system that determines a


physician’s Medicare payments. This affects Medicare reimbursement for physician services, not ASC facility fees. Physicians that bill more than $30,000 in Part B charges and provide care for more than 100 Medicare patients per year are part of the Quality Payment Program. Within the program are two tracks: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Advanced APMs are unique care models, such as some bundled episodes of care, comprehensive care models and accountable care organizations (ACO). For now, most ASC physicians will probably not be eligible for the Advanced APM track, since there are not a lot of these models that currently apply to ASCs. The vast majority of physicians who work in ASCs will fall under MIPS, as will


other ASC clinicians, such as certified registered nurse anesthetists. Clinicians who are not sure whether they are included, can enter their national provider identifier (NPI) number in a CMS tool (https://qpp.cms.gov/learn/eligibility) to find out. MIPS replaces Meaningful Use, so anyone who was subject to that program will likely be subject to this one. Essentially, MIPS ties Medicare payment adjustments to whether physicians report data corresponding to certain “performance categories,” such as Quality or Improvement Activities. The more data a physician or a group of physicians reports, the greater their potential payment update will be. MIPS reporting will be done either as an individual (using an NPI number) or as a group (using a single taxpayer identification number or TIN). This year is being labeled as a transition year. Those who report some data collected between January 1, 2017, and December 31, 2017, will be eligible for a small payment adjustment. For those who report a full 90-day period or a whole year’s worth of data, the potential adjustment goes up. Reporting no data will result in a negative 4 percent adjustment. All data must be sent to CMS by March 31, 2018, to be counted toward the 2017 MIPS payment evaluation. The first payment adjustments based on performance are set to go into effect on January 1, 2019. If you need help understanding this new reporting program, you are not alone.


Seeking Authors


ASC Focus is seeking the contribution of articles by guest authors. If you have the expertise and time to write for us, we’d be interested in hearing from you.


Please see our editorial guidelines at www.ascassociation.org/Focus and submit your story proposal to smukerji@ascassociation.org.


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For general information on MACRA/MIPs and how it might affect your ASC, please visit the ASCA web site under the “Federal Regulations” tab. You also can reach out to Kara Newbury at knewbury@ascassociation.org or Alex Taira at ataira@ascassociation.org.


Rebecca Craig, RN, CASC President of ASCA’s Board of Directors


ASC FOCUS AUGUST 2017|www.ascfocus.org


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