Skip to main content

COVID-19 RESPONSE: Recent developments are impacting our valued clients. Read these helpful resources for navigating this crisis in your business.

Getting Started: Initial Steps to Tackle MACRA Compliance

Wednesday, June 21, 2017 9:00 AM

Hot Topics, Billing, Coding & Compliance

Written by: Dixon Davis

Dixon Davis
Senior consultant

MACRA is finally here and setting the health care industry ablaze with questions about what it means and what to do. We are now in the “uh-oh, it’s here, and I better do something quick” phase.

Despite the fact that MACRA is a reality, I still hear some medical professionals state their confidence that it will go away as an excuse to not dive into it yet. Granted, we have seen the Centers for Medicare and Medicaid Services (CMS) make changes, alter implementation time frames, and delay programs in the past; however, there is a high likelihood that the philosophy of focusing a component of reimbursement on factors other than just a unit of service (i.e., quality of care and efficiency) will persevere.

Naturally, there are some who will sound the alarm bell loud and clear to generate fear or anxiety as a way to motivate people to do something. While that type of motivation can create movement, it’s usually only short-lived without any real investment. As a meaningful course of action, I prefer an honest acknowledgement and assessment of the situation while looking for opportunities to participate in a way that results in improvement and long-term benefits.

"There is a high likelihood that the philosophy of focusing a component of reimbursement on factors other than just a unit of service (i.e., quality of care and efficiency) will persevere." — Dixon Davis

For MACRA — and more specifically the MIPS option — my ideas for successful participation at this time include:

Identifying a MIPS champion. This practice staff member doesn’t have to be an expert in the field but needs to have a solid understanding of the requirements and know where to find good resources when questions arise. There are numerous resources available that are getting quite good, including some great materials directly from CMS. If possible, identify a team member who is interested in this type of work, understands process flow, and is organized.

Defining the measures you will focus on. There are many unique metrics to report, depending on specialty, so pick those that you already have confidence in or are of interest. The data collected shouldn’t just end with reporting for compliance. Remember, when tracking relevant data, it can be used to make improvements. If you still need a metrics list to choose from, click here. Clearly define and publicize the selected metrics so that everyone is aware and can contribute to their success.

Determining how you will report selected metrics. Explore whether you will report as individuals or as a group. I believe most will find greater benefit in reporting as a group — but verify what will be best for you. The actual submission can be done electronically, but manual reporting is an option. For those already submitting for physician quality reporting system and meaningful use, much of this work is already underway. In ophthalmology, consider the IRIS® Registry, submitting through your EHR system, or directly online. Then, keep it as automated as possible through electronic submission and clear written processes moving forward.

Using 2017 as a trial run. It will be easy to avoid a penalty this year. Simply submitting one quality measure and one improvement activity for any point in 2017 allows you to avoid a negative payment adjustment in 2019. That being said, if avoiding the penalty for 2019 is your only focus this year, I think you are missing a big opportunity. Use this year to practice capturing and submitting good data so that you can succeed in future years when more information is required and the competition for avoiding a penalty and getting a bonus intensifies.

Start early

I don’t want to oversimplify the preparation needed for MACRA, but I also don’t believe anyone needs to overreact or impose unneeded stress. Start early by taking a step-by-step approach and continuing to focus on providing quality medical care. Although these four pointers don’t cover everything you need for successful implementation, at this point they are good initial steps to take to ensure positive MACRA participation.

YOUR TURN: What proactive steps are you taking to ensure MACRA success? Please leave your response in the comment section below.

No Comments

Add a Comment