MACRA/MIPS 8 Step Plan

MACRA/MIPS 8 step action plan

Preparing for MACRA/MIPS? The time to plan is NOW!

MACRA signals a major upheaval in Medicare reimbursements and is the next step to drive healthcare providers from a fee-for-service payment system based on volume to a value-based care model where reimbursement is determined by outcomes: quality of care, reduced hospital admissions, lower infections rates, fewer readmissions, better patient outcomes, and improved cost control.(click here for a printable .pdf)
The implications of MACRA for clinicians providing care under Medicare Part B are real and far-reaching. Once MACRA is in place, providers will have to choose to operate under a merit-based incentive program (MIPS) or transition to an Alternative Payment Model (APM). Those who fail to choose one of these two paths will not only be excluded from bonus payments, but will also incur penalties. So although these programs are technically “voluntary,” in reality providers have little choice but to choose one or the other.

The MACRA timeline is aggressive, but unfortunately many organizations have yet to begin even preliminary preparations. One thing is certain with the release of the regulation, change is inevitable leaving no time to waste to prepare for the implementation that begins in January.

This checklist provides an overview of the things you need to be thinking about now as you get ready for full implementation.

STEP 1: Review your CMS Quality Resource

If you reported on PQRS last year, review your CMS Quality Resource and Use Report (QRUR) to compare your Quality Performance with other Providers. Know how to retrieve your QRUR here: Medicare-Fee-for-Service-Payment Knowing your level of success in the included measures will help your assess your preparedness for MIPS.

STEP 2: Decide which MACRA pathway is best suited for your practice

CMS established four paths providers may follow, each with the minimum performance threshold to avoid a payment penalty reduced. Practices can opt for advanced Alternative Payment Models (APM) as the one of the four pathways.

STEP 3: Determine if you are reporting as an individual or as a group

Depending whether you are submitting data as a group or individual, you may send your data to CMS through your electronic health record, registry or your Medicare claims process. A group planning to submit data through the CMS web interface must register for the interface by June 30, 2017.

STEP 4: Reach Out To Your EHR support staff

Your Electronic Health Record is instrumental in the process because it will collect the data you’ll need to submit in 2017. Reach out to your EHR support staff to confirm that the EHR is certified by the Office of the National Coordinator for Health Information Technology and seek any support they may offer.

STEP 5: Develop a patient portal

Explore applicable measures and improvement activities. This is the first time practices will need to report improvement activities, but the good news is they are actions that a lot of physicians are already doing, such as providing patients with 24-7 access to clinicians for urgent care needs. Additionally, if you do not have a patient portal, develop one and train your physicians and staff on its use. Offer your patients access to the portal and take actions to engage patients in portal use.

STEP 6: Start reporting, between January and September of 2017

Reporting can start at any time between January and September of 2017 and it ends on December 31, 2017. The size of your payment adjustment will depend both on how much data you submit and your quality results. If you're reporting includes the entire year, your practice will benefit more than if you only report on a 90-day period. However, both options will allow you to avoid a 4% payment adjustment from CMS. Learn more about reporting at

STEP 7: Get your data into CMS

Data reported is due to CMS by March 31, 2018. CMS will give you feedback about the data you reported that year. If you earn a positive MIPS payment adjustment, it will be applied beginning in January, 2019.

STEP 8: Call Tower Physicians Solutions with questions

Tower Physicians Solutions can provide you with the resources needed to determine the best quality measures for you and your practice. Tower will determine which measures you are performing well in and create a strategy for how to meet other measures. Tower experts will help you become fully prepared for MACRA implementation. There’s a lot to digest in this hefty rule and a great deal at stake, including hundreds of millions of dollars in penalties and incentives. If you have concerns, please contact Tower Physicians Solutions.
Click to call: 630-243-5731