September 28, 2017
Area(s) of Interest: Payor Issues and Reimbursement
Physicians who hope to earn a small bonus for the 2017 Medicare reporting year must start their 90-day performance period no later than Monday, October 2, 2017. While the actual reporting deadline is March 31, 2018, physicians need to identify and understand the measures that are relevant to their practice in order to successfully report on claims for the final 90 days of 2017.
Physicians that are reporting via claims will need to begin indicating the quality data code for the quality measure on the claim form beginning with October 2 dates of service as they submit these claims to Medicare.
And don’t forget, free assistance is available for small practices through the California Health Information Partnership & Services Organization (CalHIPSO).
Beginning with the 2017 reporting year, eligible physicians who do not participate in the Medicare Quality Payment Program (QPP) will see a negative 4 percent payment adjustment in 2019. QPP is the new physician payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA) and administered by the Centers for Medicare and Medicaid Services (CMS).
During the 2017 transition year, CMS will allow physicians to select one of three “pick your pace” participation options. Participating at any level in 2017 will ensure that you will not be hit with the 4 percent pay cut in 2019. The participation levels include:One patient, one measure: The most lenient participation option, this option allows physicians to avoid a penalty by "testing" the program to ensure that their systems are working and that they are prepared for broader implementation in 2018 and beyond. Physicians only need to report on one measure for one patient to avoid a negative penalty in 2019.90 Days: Physicians can choose to report for 90 days and possibly earn a small bonus payment. If you plan to select this 90-day reporting option, your performance period must begin no later than October 2, 2017.Full Year: Physicians can also choose, if they are ready, to report a full year of data in 2017 and be eligible to receive a modest bonus, depending on their performance.
Providers with less than $30,000 in Medicare payments or fewer than 100 Medicare patients are exempt from the reporting requirements in 2017. If you are unsure of your QPP participation status, you can look it up here.
FREE assistance for small practices
California physicians in practices of 15 or fewer can receive free assistance to prepare and participate in the QPP through the CalHIPSO. They will help you select the right participation “pace” for your practice, navigate the new landscape, assess performance data and stay informed about the QPP. Contact CalHIPSO now to register for services and receive no-cost technical assistance.
CMA MACRA Resource Center
To help physicians understand the payment reforms and prepare for the transition, CMA has published a MACRA resource page. There, you will find an overview of MACRA and a comprehensive list of tools, resources and information from CMA, the American Medical Association and CMS.