CMS eliminates penalties for first year of MACRA and offers “pick your pace” options

September 15, 2016
Area(s) of Interest: MACRA Payor Issues and Reimbursement Practice Management 

The Centers for Medicare and Medicaid Services (CMS) announced on September 8 that it will allow physicians to choose the level and pace at which they comply with the new MACRA Medicare payment reforms. Participating at any level in 2017 will ensure that you will not be hit with payment penalties in 2019.

The welcome announcement comes after the California Medical Association (CMA), American Medical Association (AMA) and other physician stakeholders urged CMS to ease the burdens and delay the first MACRA reporting period to give physicians more time to prepare.

MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) repealed the flawed sustainable growth rate payment system, and established two payment paths:  1) A fee-for-service path that consolidates the current reporting programs under the Merit-Based Incentive Payment System (MIPS) and 2) an Alternative Payment Model (APM) path. CMS will begin measuring performance for eligible clinicians in 2017, with payments based on those results beginning in 2019.

Under the MIPS fee-for-service program, the most lenient participation option would allow physicians to simply "test" the program to ensure that their systems are working and that they are prepared for broader implementation in 2018 and beyond. While physicians who choose this option will not receive bonus payments, they will avoid a negative penalty.

Under the second option, physicians can opt to submit data for less than the full reporting year. While CMS has not yet specified the timeline, CMA believes the 2017 reporting period could be only 90-180 days.  Physicians who choose this option would not only avoid a negative payment adjustment, but could receive a small bonus.

Physicians can still choose, if they are ready, to report a full year of data under MIPS in 2017 and be eligible to receive a modest bonus, depending on their performance.

The APM program is largely exempt from the MIPS criteria.

Details about the participation options will be described fully in the final rule that will be published November 1. CMA will provide additional information when available.

Click here to read the announcement.


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