Medicare

MACRA penalties can now be avoided, CMS says

Avoiding penalties under the Medicare Access and CHIP Reauthorization Act (MACRA) just got easier. The Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt Thursday announced that the final MACRA regulation will exempt physicians from any risk of penalties if they choose one of three distinct reporting options in 2017.

In a blog post, Slavitt announced that CMS heard physicians’ concerns about the proposed start date for performance reporting under the new Medicare payment system and that the agency will offer three reporting options for the Merit-based Incentive Performance System (MIPS)—and if you choose one for 2017, you will not receive a negative payment adjustment in 2019.

The options will be described fully in the final rule, but here are the basics:

  • Option one: Test the program - As long as you submit some data to the Quality Payment Program, including data from after Jan. 1, you will avoid a negative payment adjustment, Slavitt said. This option is intended to ensure that the system is working and that physicians are prepared for broader participation in the coming years as they learn more.
  • Option two: Partial-year reporting - Physicians can choose to report Quality Payment Program information for a reduced number of days. Your first performance period could begin well after Jan. 1 and your practice could still qualify for an incentive payment. Slavitt offered an example. “If you submit information for part of the calendar year for quality measures, how your practice uses technology and what improvement activities your practice is undertaking,” he said, “you could qualify for a small positive payment adjustment.”
  • Option three: Full-year reporting - If your practice is ready to get started on Jan. 1, you can choose to report Quality Payment Program information for the full calendar year. Your first performance period would begin on Jan. 1, and if you submit information for the entire year your practice could qualify for a modest positive payment.
  • Advanced Alternative Payment Model (APM) option - This option is still available and qualified participants in advanced APMs will be eligible for five percent incentive payments in 2019.

Choosing any of these options guarantees that you will not receive a negative payment adjustment.

The announcement confirms that physician input is playing a critical role in the development of the final MACRA rule. Slavitt stated his appreciation for the constructive participation of physicians in the feedback process and added that CMS looks forward to further engagement with physicians to make sure the new Medicare payment system works for everyone, including patients.

"By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA,” said AMA President Andrew W. Gurman, MD, in a statement commending Slavitt and Department of Health and Human Services Secretary Sylvia Mathews Burwell.

“This approach better reflects the diversity of medical practices throughout the country,” he said. "The AMA believes the actions that the Administration announced today will help give physicians a fair shot in the first year of MACRA implementation.”

This kind of flexibility is what physicians were seeking throughout the draft rule comment period—and now it is a reality. The only way to receive a negative payment adjustment now is by not participating at all.

More resources and tools are provided by the AMA are available to help your practice navigate Medicare payment reform.