The road ahead: Regulatory updates for 2016

SourceMed recently hosted a webinar that took a closer look at the road ahead when it comes to payment and reporting models.

Beyond simply understanding that a shift is happening, it’s important to take a closer look at the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Signed into law last April, MACRA has led to several positive developments, including the permanent repeal of the Sustainable Growth Rate. This means that payments will increase by .5 percent this year through 2019 before flattening out between 2020 and 2025.

MACRA's passage will also lead to the Merit-based Incentive Payment System, or MIPS, the eventual replacement for PQRS. MIPS will begin next year for physicians and in 2019 for other providers.

With PQRS, 2014 was a big year for reporting as it determined compensation for 2016. Unfortunately, approximately 70 percent of providers did not properly report in 2014 due to issues with Measure #130 and are now dealing with a 2 percent non-compliance penalty.

2016 is another important reporting year. Eligible providers who bill under the physician fee schedule must report successfully to avoid a 2 percent reduction in 2018. It’s critical to report at least nine measures. To help you properly report, we’ve created a reference guide with nine common measures, including required Measures 128, 130, 131, 154, 155 and 182. {Include link to download PQRS Quick Guide}

In the future, some of the PQRS measures will likely move and become part of MIPS. As of right now, MIPS seems to be comprised of:

  • 45 percent quality measures
  • 15 percent resource use
  • 15 percent clinical activities
  • 25 percent meaningful use

It is anticipated that MIPS data will become mandatory rehabilitation providers in 2019, with penalties kicking in starting in 2021.

Therapy Cap
Yes, the therapy cap is still around and will remain in place until the end of 2017.

Correctly calculating the cap is important. It is based on allowed charges after your MPPR has been applied but before the 1.6 percent government sequestration has been applied. For example, if your allowed charge is $122.79 and your discounted payment after MPPR is $111.40 (-9.28 percent), your total compensation after sequestration will be $109.61. Keep in mind that Medicare pays 80 percent of the allowed amount.

Innovative Payment Models
The biggest focus in healthcare today and the future is on quality and outcomes, which is making way for value-based and alternative payment models. Moving forward, the Department of Health and Human Services plans to have 30 percent of payments tied to alternative payment models by 2016 and 50 percent by the end of 2018. In addition, 85 percent of fees for services are expected to be tied to outcome measures this year and 90 percent by the end of 2018.

To maximize payments, begin familiarizing yourself with the Bundled Payments for Care Improvement Initiative, the Comprehensive Care for Joint Replacement Model, and the CJR Model, which has been implemented in 67 large counties with core urban populations.

The ultimate goal of each of these innovative payment models is better, more efficient care.

For more information and details, download the complete webinar and presentation deck here.

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