Home Health Insurance Why MACRA Matters


Why MACRA matters

With the current political environment, there’s been a lot of talk about health care in our country.  Even though we don’t know what all the changes will be, the Center for Medicare and Medicaid Services (CMS) has been moving ahead with new rules for Medicare reimbursements to clinicians.  The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the old formula for physician Part B reimbursements replacing a broken, frustrating and needlessly unpredictable system. This new system stabilizes Medicare payments and has the potential to reward physicians for what they do best— providing quality, high-value care.

The new rules went into effect 1/1/17 and are complex and detailed.  Many practitioners seeing Medicare patients have a very low level of awareness of these rules, (less than 50% in one survey), and see them as difficult to understand and complex to follow.  However, one thing is clear –  MACRA will affect clinician’s bottom lines, through penalties for non- compliance and possible bonus payments for full reporting and strong metrics.  So, what is a clinician to do?

CMS estimates that MACRA implementation will take additional resourcing to achieve compliance, so most groups will need some form of assistance to first interpret, then educate, implement and help in reporting.   Some of the ways that outside assistance can be used are:

  • The new rules are complex – most organizations will need help in interpreting, explaining and educating their staff on the measures and reporting processes
  • The financial impacts can be significant, so estimating the penalties/impacts of MACRA need to be calculated and the benefits of improving the measures estimated
  • The new rules do increase workload, so understanding the future vision of the Medicare business for an organization is critical as well – what is the long -term plan for this business?
  • Reporting under MACRA requires technology, so evaluating the organization’s technology readiness and identifying/closing gaps is also important for compliance
  • With the new measures, clinicians have opportunities to select which measure to report in certain categories, so helping to choose which measures are strong or could be improved is a key part of the strategic planning process as well. This could also be combined with process improvement strategies to improve measures and subsequent reimbursements.

Clinicians should choose external help based on those with Medicare and CMS/MACRA expertise, as well the ability to educate staff and also understand and close technology gaps.  Don’t delay, though – because with the rules already in effect, earlier compliance will mean better revenue solutions.





TahoeSmart guest blogger Shaila Kapur is passionate about improving the customer experience, having worked extensively in both healthcare and banking. She is presently Principal at Mergence Advisors, and was formerly Customer Experience Executive at Independence Blue Cross. Shaila holds an MBA from Michigan State University and is a frequent blogger about the customer experience.