MACRA facts that every clinician should know [Infographic]

November 11th, 2016 - Adam Smith   
Categories:   Medicare   Medicare Advantage   Medicare Claims Processing Manual   Medicare Physician Fee Schedule (MPFSDB)   Physicians  

MACRA is here and the new program is going to sunset several (un) popular programs such as Meaningful Use and the Value Based Payment Modifier model. Everybody who is anybody is busy discussing about MACRA and its ramifications. But as with any big updates the myths are jostling for space with the facts. We’ve sifted the facts from the myths for you.

Macra Certification

Myth #1: MACRA will make maintenance of certification mandatory

Fact #1: MACRA doesn’t make it mandatory for physicians to participate in maintenance of certification. It is certainly not compulsory.

Myth #2: MACRA will affect only physician reimbursementsPhysician Reimbursement

Fact #2: There is a common myth that MACRA will only affect physician reimbursements. It will affect the reimbursement of all eligible clinicians. The eligible clinicians who will have to report under MIPS are physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurses and anesthetists.

MIPS and AAPM

Myth #3: Clinicians can choose between MIPS and  participating in AAPMs right at the outset.

Fact #3: All eligible clinicians will report under MIPS during the first year. CMS will select qualifying physicians to participate in AAPMs after evaluating their quality scores.MIPS Penalties

Myth #4: MIPS penalties are higher than the current quality measure programs

Fact #4: MIPS stream lines and consolidates 4 different programs under one umbrella. Instead of paying separate and sometimes expensive penalties for failing to meet different pay for performance programs, clinicians who report under MIPS will only have to pay a 4% penalty during the first year.

Myth #5: MACRA will penalize physicians who follow the fee for service model

Fact #5: It does not. Physicians can still choose to continue working with the FFS model can still participate in the MIPS program.

Click on the image below to enlarge

MACRA Facts & Myths

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association