MHMD: Chronic Disease Management Programs

Information about the MACRA Final Rule

Final Rule

On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule, with comment period, implementing the Quality Payment Program that is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This new legislation ended the Sustainable Growth Rate (SGR) formula, which threatened clinicians participating in Medicare with potential payment cliffs for 13 years, and introduced a new Medicare value-based reimbursement system that will impact Medicare reimbursement amounts beginning in 2019. This new system, called the Quality Payment Program (QPP), repeals SGR and is made up of two participation tracks—the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). If you are a clinician that bills services under the Medicare Physician Fee Schedule, understanding the requirements and payment changes under MACRA is very important since payment adjustments that occur in 2019 will be based on action and performance starting January 1, 2017.

The Quality Payment Program’s purpose is to provide new tools and resources to help physicians give patients the best possible, highest-value care. The Quality Payment Program policy will reform Medicare payments for more than 600,000 clinicians across the country, and is a major step in improving care across the entire health care delivery system. Providers can choose how to participate in the Quality Payment Program based on practice size, specialty, location, or patient population.

CMS MACRA Final Rule (From the Registrar Office)

CMS MACRA Final Rule Fact Sheet

CMS MACRA Final Rule Executive Summary

Helpful Resources

CMS MACRA Webinar Presentation (October 2016)

MHMD MACRA Presentation (December 2016)

Obtaining Your QRUR Report (Quality Resource Use Reports)

Your first step is to obtain your QRUR (Quality Resource Use Reports) for 2014 & 2015 mid-year.
Obtain your report here: (https://portal.cms.gov).
Know how your practice fared under the Value-Based Payment Modifier (VBPM) program: (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/2014-QRUR.html).
Next, develop a Quality Improvement (QI) plan incorporating results from your QRUR report.