American Society of Hematology

MACRA Frequently Asked Questions

If you are a physician, physician assistant, nurse practitioner, clinical nurse specialist, or a certified registered nurse anesthetist billing Medicare Part B, you must participate in the Quality Payment Program. If you are not in an Advanced Alternative Payment Model (APM), you must participate in the Merit-based Incentive Payment System (MIPS).

You may be excluded from MIPS if you are:

  • Newly-enrolled in Medicare, meaning you enrolled for the first time during the performance period;
  • You are below the low-volume threshold, meaning your Medicare Part B allowed charges are less than or equal to $30,000 a year OR you see 100 or fewer Medicare Part B patients a year; or
  • You are significantly participating in Advanced APMs, meaning you receive 25 percent of your Medicare payments or see 20 percent of your Medicare patients through an Advanced APM.

MIPS consolidates three existing programs, Meaningful Use (MU), the Physician Quality Reporting System (PQRS), and the Value-Based Modifier (VBM), all of which will sunset at the end of 2018 when the final penalties are assessed. MIPS is made up of four performance categories, each of which will be combined to create a clinician's or group's Composite Performance Score. The categories and corresponding weights for 2017 are listed below:

  • Quality (60%)
  • Advancing Care Information (25%)
  • Clinical Practice Improvement Activities (15%)
  • Cost (0% for 2017, but will be weighted in future years)

Bonuses and penalties will be assessed two years after each performance period, with the first performance year being 2017, and the corresponding payment adjustments coming in 2019.

The Centers for Medicare and Medicaid Services deemed 2017 a transition year for MIPS, allowing participating clinicians to "pick your pace."

To avoid a penalty: Clinicians can submit as little as one Quality measure OR one Improvement Activity OR the required base score measures for Advancing Care Information.

Partial Year: Clinicians may submit for a continuous 90 days of 2017 data to Medicare by March 31, 2018. In order to meet the 90 day minimum, you can start collecting data anywhere between January 1, 2017 and October 2, 2017. To meet the requirements, clinicians must report more than one Quality measure, more than one Improvement Activity, and more than the required base score measures for Advancing Care Information.

Full Year: Clinicians must report all of the required data for a minimum of a continuous 90-day period, a full year, or anything in between. See the description of each performance category to learn what the requirements are for each.

Not participating in the Quality Payment Program for 2017 will result in a negative 4 percent payment reduction in 2019.

You can report as an individual, using a National Provider Identifier (NPI) number and Tax Identification Number (TIN) where they reassign benefits, or you can report as a group, requiring two or more clinicians (identified by their NPIs) who have reassigned their billing rights to a single TIN or submitting as an Alternative Payment Model (APM) entity. Reporting methods vary for each performance category and for the method of reporting. See details in the table below.

Performance Category Individual Group
Quality
QCDR (Qualified Clinical Data Registry)
Qualified Registry
EHR
Claims 
Administrative Claims 
CMS Web Interface (groups 25 or more)  
CAHPS for MIPS Survey 
Advancing Care Information
Attestation
QCDR
Qualified Registry
EHR Vendor
CMS Web Interface (groups of 25 or more) 
Improvement Activities
Attestation
QCDR
Qualified Registry
EHR Vendor

The Quality Performance Category replaces the Physician Quality Reporting System (PQRS). For 2019, this category will be weighted 60 percent.

To meet full reporting requirements for the Quality Performance Category:

  • Report on at least six of the available quality measures, including one outcome measure. If an outcome measure is not available that is applicable to your specialty or practice, choose another high priority measure. There is no specialty measure set available for hematology or oncology at this time.
  • Clinicians are required to report on 50 percent of patients.
  • Bonus points are available for submitting an additional high-priority measure or for using Certified Electronic Health Record Technology (CEHRT) to submit measures to registries or CMS.

Explore the measures, here.

The Advancing Care Information (ACI) Category replaces the Medicare Meaningful Use program. For 2019, the ACI Category will be weighted 25 percent.

For the 2017 Transition Year, minimum requirements include submitting all five of the base score measures. For 2017, clinicians have two options for reporting measures under this category; the requirements differ based on whether your EHR meets the 2014 or 2015 certification requirements. All clinicians must be on the 2015 Certified Electronic Health Record Technology (CEHRT) beginning with the 2018 performance period. Additionally, for the transition year, there are two ways to earn a bonus in this category:

  • Reporting “yes” to 1 or more additional public health and clinical data registries beyond the Immunization Registry Reporting measure will result in a 5% bonus.
  • Reporting “yes” to the completion of at least 1 of the specified Improvement Activities using CEHRT will result in a 10% bonus.

To meet full reporting requirements for the Advancing Care Information Performance Category:

  • Report data on all five base score measures. The base score will account for 50% of the ACI Performance Category score. Clinicians must meet criteria for all base score measures to receive any score in this category.
  • Report data on additional performance score measures. The performance score measures will allow clinicians to earn an additional 50% for their score.

Learn more about the measures, here.

The Improvement Activities Performance Category is a new category under the Quality Payment Program. For 2019, the Improvement Activities Performance Category will be weighted 15 percent. For the 2017 Transition Year, minimum reporting requirements only require clinicians to submit one improvement activity. To meet full reporting requirements for the Improvement Activities Performance Category:

  • Attest completion of two high-weighted, at least four medium-weighted activities, or a combination of high- and medium-weighted activities to total 40 points. An activity must be performed for at least 90 days during the performance period to receive credit. Patient-centered medical homes (PCMH) will automatically receive full credit.

Groups with fewer than 15 participants or those in a rural or health professional shortage area will only have to attest for one high-weighted activity or two medium-weighted activities.

To explore improvement activities, click here.

The Cost Performance Category replaces the Value-Based Modifier program and for the 2017 performance year and the corresponding 2019 payment year, this category will be weighted at zero percent. We will update this section as necessary.

October 2, 2017: Last day to start collecting data in order to participate in the 90 day minimum, partial year reporting.

March 31, 2018: Data submission deadline for MIPS data collected in performance year 2017.

If you are participating in the Oncology Care Model (OCM) and the model does not qualify as an Advanced APM, you are still required to participate in MIPS, this is known as a MIPS APM. For details on reporting, see below:

  • Report Quality measures as required by the terms of the OCM.
  • No additional Improvement Activities are required, practices will receive the full score for this category by participating in the required activities for the OCM.
  • OCM practices must comply with the Advancing Care Information requirements under MIPS.

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