A group of selected HBMA members, along with the HBMA GR Committee, is reviewing the proposed rule by CMS that details how it would implement the new Medicare value-based payment systems created by MACRA. The Medicare Access and CHIP Reauthorization Act (MACRA) is a counter-measure for the Sustainable Growth Rate (SGR) method, which was highly opposed and criticized by the Congress. MACRA promises to provide payment updates for a couple of year before implementing the value-based payment options.
Most of the healthcare units are likely to participate in the Merit-based Incentive Payment System (MIPS), which reforms PQRS, Value Modifier, and EHR Meaningful Use into a better reporting and assessment module. MIPS mandates each healthcare providers to report under the designated categories, and ranks them based on their performance, quality of services provided, cost of care, use of advanced technologies, as well as use of medical practice improvement activities. This ranking system is then used to determine the payment adjustment a provider would receive.
Healthcare providers can also participate in Alternative Payment Models (APM), which hold providers responsible for revenue risk and quality of care. Healthcare units that reach a participation threshold for APMs approved by CMS can escape MIPS reporting and will also be eligible for a bonus payment claims per year, as long as they meet the threshold. In addition, they can also earn through the actual APM structure.
The HBMA team is carefully evaluating the operational as well as administrative challenges the new payment system pose. Experts will also try to figure out the potential issues that need to be addressed urgently with the CMS in a conference meet or through any other proper channels.