Healthcare is buzzing as MACRA (Medicare Access and CHIP Reauthorization Act of 2015) and Medicare payment reform is implemented. Providers and healthcare organizations will see a number of changes as a result of this process. There is so much to learn and prepare for moving ahead!

I recently sat down armed with questions from our clients, along with a number of questions we received while attending Spring conferences for our resident MACRA expert and Compliance Consultant, Kathryn Ayers Wickenhauser. In this interview, she breaks down the top things you need to consider as you prepare for MACRA. -Jamie


JV: Kathryn,  I know you’re asked often if participation in MACRA is optional. Is it?

KAW: Nope! All providers who receive reimbursement from Medicare fall into the pool of Providers this impacts.

JV: What about commercial insurance payers? Where do they fit in this reform?

KAW: Commercial insurance payers are expected to follow suit; CMS institutes, commercial payers follow suit, so it’s important to pay attention to the payment reform process, even if you don’t believe it currently impacts you. This will effect everyone in healthcare at some point.

JV: Can you give us a timeline on what we can expect to see with MACRA implementation?

KAW: MACRA initially passed into law April 15th, 2015, but another more specific proposed rule released and recently closed for comment at the end of June, 2016.  We await the specific standards with baited breath, as the first reporting period begins January 1st, 2017… six months from now! The results of MACRA will be published annually, and will be accessible to consumers through the Physician Compare website, one of the government’s most frequently visited websites.

JV: As Providers prepare for MACRA standards, what options do they have?

KAW: Providers can choose from one of two paths depending on their eligibility: MIPs (Merit Based Incentive Payment Systems) or APM (Advanced Payment Models). It’s expected most providers will participate in MIPS, and all Providers are requested to report on MIPS for the first reporting period.

JV: Can you help clarify the definition of MIPS and what it includes, please?

KAW: Think of MIPS as essentially an umbrella program that rolls up Meaningful Use, PQRS, and VBM into one program. The idea is it’s easier to report on one Pay-for-Performance program rather than separate and disparate programs.

JV: So, it’s safe to say that with the four categories within MIPS, Meaningful Use is ending?

KAW: Not quite! Essentially Meaningful Use has undergone a makeover and is now the “Advancing Care Information” category. MIPS has three other categories, Quality, Cost, and Clinical Practice Improvement Activities. Quality replaces the PQRS program, Cost replaces the VBM, while Clinical Practice Improvement Activities is new to the equation.

JV: With all these changes, are providers still required to do a Security Risk Analysis annually?

KAW: Yes! It’s not only required by HIPAA, but MACRA will also require it annually. In order to receive any points in the Advancing Care Information category of MIPS, a SRA (Security Risk Analysis) must be performed.

JV: If our readers need help with a Security Risk Analysis (SRA), where should they look?

KAW: One of the focuses of my consultancy at ScanSTAT is performing SRAs for our clients. My team and I are happy to help talk through providers’ needs and give them assistance in meeting this important criteria for HIPAA and MACRA compliance.

JV: For more information about Kathryn’s SRA service offerings, please click here. This is much like home improvement projects at my house–it’s always best to turn to an expert to ensure the job is completed on-time and properly!

JV: You’ve shared some very straight-forward information, I appreciate you breaking down in an easy-to-digest manner for me and our readers alike. Closing thoughts for our readers, Kathryn?

KAW: Sure Jamie!  As we have seen, healthcare is changing fairly rapidly as we strive to increase quality and decrease cost in the healthcare marketplace.  The move to MACRA is an extremely impactful change.  It is important healthcare organizations get buy-in from their Providers and start preparing now if they want to maintain a similar level of reimbursement, or even increase their reimbursement! Money talks, right? MACRA cannot be ignored, it’s right around the corner!

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