The US healthcare sector changes frequently. One of the most significant evolutions over the past decade has been moving from volume-based to value-based care. This will incentivize healthcare providers to deliver excellent patient care in a timely manner, as opposed to the quantity of services they provide.
Given this situation, learning what is MACRA and MIPS? is essential for all healthcare professionals. These two proposed programs, MACRA (Medicare Access and CHIP Reauthorization Act) and MIPS (Merit-Based Incentive Payment System) were created to make certain that healthcare providers continue to provide better care while also being more cost-conscious.
If you need a MIPS registry, practice administrator or clinician aiming to increase reimbursements and avoid penalties, this guide will also help provide understanding of what is MACRA and MIPS.
What is MACRA and MIPS?
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 introduced major changes in the way Medicare determines payments for services. MACRA implemented a new framework for payments to incentivize value-based care. Rather than rewarding volume, it rewards values so that clinicians who make a difference to patient lives through preventive care and containing the cost of services can be recognized.
It did so by laying two primary paths for healthcare providers in MACRA:
- MIPS (Merit-Based Incentive Payment System)
- APMs (Advanced Alternative Payment Models)
Our MIPS consulting services would be the most beneficial as it encompasses many clinicians such as physicians, physician assistants, nurse practitioners and other eligible professionals. So, when someone wonders what is MACRA and MIPS, it is basically how do we measure the healthcare providers and pay them based on the quality, efficiency, effectiveness of their care.
Role of MACRA in Healthcare
MACRA is intended to promote positive changes in health care by pursuing three principal goals:
Improving Patient Care
It is a quality-based program that motivates providers to use evidence-based practices to improve patient safety and satisfaction.
Promoting Value Over Volume
Until now, providers were financially rewarded for ordering more tests or procedures even if patient outcomes did not improve. With MACRA, payments are intended to reflect the value of care instead of volume.
Enhancing Accountability
Transparent performance reporting under MACRA means providers can be held accountable for their clinical and financial outcomes and the incentives are aligned with better healthcare delivery.
Performance Categories of MIPS
Based on performance, providers may receive payments or credits for participating in Advanced Alternative Payment Models (Advanced APMs) or Merit-Based Incentive Payment System (MIPS). It would also consolidate a few separate Medicare programs into a single system.
MIPS measures performance of providers on four primary criteria which contribute a percentage to the MIPS score:
Quality
Outcome in this domain refers to how well care is delivered, how safely it is provided, and the extent that provision of care aligns with patients’ preferences. Providers report quality measures on patient outcomes, hospital readmissions and preventive screenings.
Cost
Cost metrics assess how cost effective a provider was in delivering care. Medicare reviews claim to see what resources and costs it uses per doctor compared with peers.
Improvement Activities
This category aims to recognize providers that have gone the extra mile in areas such as patient safety, patient engagement and clinical practice. This might be caring coordination and patient education that integrates into telehealth.
Promoting Interoperability
This category evaluates how efficiently they use certified Electronic Health Record (EHR) technology to exchange health information about patients in an effort to enhance care coordination among their healthcare teams.
Benefits of Participating in MACRA and MIPS
Although participating in MIPS can seem complicated, the payoff for doing it well is huge:
- Enhanced Patient Outcomes – Care delivery types are improved towards overall health outcomes and patient satisfaction.
- Higher Reimbursement Rates – A strong MIPS score is resulting in large payment increases from Medicare.
- Practice Efficiency – Prioritizing cost and quality to root out waste and streamline processes.
- Data-Driven – Reporting of MIPS data drives the provider to track performance and develop strategies to improve that performance.
- Better Reputation – With your MIPS scores laid out for all to see, you are sending a message that quality matters to you and that people will get better results when they turn to your practice. This can help attract more patients and create even deeper trust in the community.
How Can Prime Well Med Solutions Help You?
The ins and outs of what is MACRA and MIPS can seem daunting to harried physicians. Prime Well Med Solutions makes it easy with MIPS services customized for your practice.
Our experts assist with:
- MIPS reporting and performance tracking
- Compliance with CMS requirements
- Quality data collection and analysis
- Technology integration and EHR optimization
- Optimizing reimbursement potential with appropriate claims submission
With Prime Well Med Solutions, you can be confident that your practice will meet deadlines and avoid penalties without limiting the time you dedicate to what matters the most that is delivering quality patient care.
Wrapping Up
In short, what is MACRA and MIPS creates a contemporary structure for value-oriented care in America. These programs, by placing an emphasis on quality, efficiency and interoperability will change the way that healthcare providers are paid to treat patients.
If you want to simplify your MIPS participation process and receive the maximum reimbursement, contact Prime Well Med Solutions today!