Changes in MACRA will be affecting the reimbursement for the providers here are some things to look for in Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (AAPM).

1. Call now 888-357-3226 (Toll Free)
info@medicalbillersandcoders.com
www.medicalbillersandcoders.com
Copyright ©-2017 MBC. All Rights Reserved1
MACRA Releases Final Rule for 2018 Performance
CMS has issued the final rule for 2018 for the Quality Payment Program (QPP). The QPP program is in the second
year of implementation continually trying to adjust the QPP to become more comprehensive and offer better
incentives for the providers.
Changes in MACRA will be affecting the reimbursement for the providers here are some things to look for in Merit-
based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (AAPM).
A thorough analysis of the MACRA 1,653 pages rulebook we have created chosen the rules which will affect your
billing to the maximum.
Merit-based Incentive Payment Model (MIPS)
1. CMS has added leniency for providers affected by natural disasters e.g.:- Fire, Hurricane
For the 2018 rule, CMS has made provisions for uncontrollable circumstances of natural disasters and health
emergencies to submit hardship exception applications. This would mean that the CMS would reconsider
the advancing-care information for 2017 and for the quality, cost, and improvement for 2018. CMS has also
exempted many clinicians for quality, improvement and cost categories in 2017. The final rule for the
following will not take effect from 2018.
2. For 2017 the final score which would depend on the quality-60 percent, improvement activities-15 percent,
cost- 0 percent and for the advancing care-25 percent. For 2018 the performance for 2018 is the quality- 50
percent, Advance care information- 25 percent, cost-10 percent and improvement activities-15 percent.
3. Bonus Opportunities for providers
Small practices which have 15 or less number of physicians can also 5 additional points if they submit on one
performance category. Physicians can also earn upto five more points for treating complex patients. For all
patients eligible for Medicare and Medicaid insurance.

2. Call now 888-357-3226 (Toll Free)
info@medicalbillersandcoders.com
www.medicalbillersandcoders.com
Copyright ©-2017 MBC. All Rights Reserved2
4. Threshold for revenue and patient raised
In 2017, if providers have billed less than $30,000 for Medicare Part B or treated less than 100 patients who
are beneficiaries of Medicare Part B. In 2018, the bare is promoted to $90,000 and 200 patients annually.
Individual physicians or physicians of less than a group of 10 can band together to report the MIPS
parameters.
APM
Extended Advanced APM by two years
This says that at least 8 percent of physician’s revenue has to be in risk to qualify for the extension of performance
for the year 2020. The performance standard will be extended till 2020, this rule applies to the physicians under the
financial risk and who are APM under the non-Medicare payers can also qualify for the Advanced APM.
The rulebook also provides information on All-payer combination model which will be available by 2019. This will
include the determination and data submission for the model which will allow the physicians to qualify for the
Advanced APM.
The CMS rules have had a mixed reception, while some providers have lauded CMS and others say that it could have
been better under the new regulations. Some of the physicians supported saying that the administration has
continued providing the flexibility for the participation of providers. However some of the feel that the CMS has
shied away from the value based just to maintain the equilibrium for the providers.
It seems like the CMS want to ease out the process of value-based payment model for the providers before fully
plunging into the model. This will provide with a breather for the individual physicians and small practices. While in
later years how the practices would be taking the leap for the value-based care would be an interesting factor to
see.
While ASC and emergency service providers feel left out with non-expected departments where the 10 points where
cut-down bringing it from 50 percent to 40 percent.
For more information on effects of MACRA rule on your practice contact us through our medical billing and coding
specialist.