HITapproved Industry Highlights
With kickoff of the inaugural MACRA reporting period nearly upon us, many healthcare providers will greet 2017 with quality payment program objectives top-of-mind. The new pay-for-performance reimbursement landscape will usher in the adoption of new clinical and technical workflows as physicians work to meet the goal of driving better patient outcomes through smarter healthcare resource utilization. The cornerstone of these initiatives, however, is an effective financial strategy.
As the market responds to continued pressure to reduce healthcare costs – and with costs expected to consume 20% of the US economy by 2020 – the march to value-based care will pick up speed in 2017. Healthcare pundits have been focusing on how the ACA will be repealed or replaced—but don’t let that noise distract you. In reality, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is the legislation that mandates the transition to value-based care – and no one in Washington is considering repealing it.
When CMS released the Notice of Proposed Rule (NPRM) for the implementation of the Medicare Access and CHIP Reauthorization Act – better known as MACRA – in April of this year, howls of protest could be heard throughout the healthcare landscape.
When it comes to HIPAA compliance, no stone can be left unturned. The most recent HIPAA settlement announced by the Office for Civil Rights (OCR) in the Federal Department of Health and Human Services continues the trend of using settlement agreements to highlight specific areas of HIPAA for compliance.
Last month I wrote a post entitled, MIPS: The Tyranny of the Composite Score. The majority of Medicare Part B providers (those not in the Advanced Alternative Payment Model (APM) bubble) will have reimbursement directly and deeply impacted by the Merit-based Incentive Payment System (MIPS). A provider’s annual score (0-100) will be the holy grail in this new game of “pay for value” competition. For the most part those that will be affected have no idea that the reimbursement landscape has changed. They will know soon enough.
The move toward an interoperable electronic health care data system has been stimulated by a system of incentives, penalties and pay adjustments for providers. The CMS EHR Meaningful Use (MU) programs were a prime example of this process. It was the proverbial carrot and stick approach. Meet the requirements and gain incentives or just ignore the whole thing and maybe get dinged down the road.
By now you’ve probably heard that one of the outcomes of the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is that the Centers for Medicare and Medicaid Services (CMS) will be replacing the old Health Insurance Claim Number (HICN) on Medicare cards with a new, randomly generated Medicare Beneficiary Identification (MBI) code. Officially, the change is known as the Social Security Number Removal Initiative.
With the recent release of the MACRA final rule, the Centers for Medicare & Medicaid Services (CMS) confirmed that they remain committed to implementing the legislative requirements in less than 3 months, but did make some provisions to satisfy provider concerns. Briefly, the final rule said that CMS decided to increase the flexibility of the Medicare Access and CHIP Reauthorization Act (MACRA).
MIPS relies on the calculation of a composite (or final) score based on the linear combination of 4 factors (except 3 for 2017), each multiplied by its corresponding weight as explained in the more than 2000-page Final Rule. The factors and their weights for 2017 are Quality (60%), Improvement Activities (15%), and Advancing Care Information (25%).