The Guidebook to Medicare Access and CHIP Reauthorization Act of 2015 dispels MACRA myths and puts you in the know with easy-to-follow guidance. Interpret MACRA changes with step-by-step advice to understand and master MACRA’s final rule.

1. The Merit-based Incentive Payment System (MIPS)

2. How Will the Merit-based Incentive Payment
System (MIPS) Impact You?
MACRA replaces three Medicare reporting programs with MIPS:
1. PQRS
2. Value Modifier
3. The EHR Incentive Programs
With the three previous programs combined, medical practices would
have faced a negative payment adjustment as high as 9% total in 2019.
MACRA reduces the potential negative payment adjustments and
streamlines the overall requirements.
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3. 2017 – 2019 Transition Overview for Medicare
Programs
2017 2018
PQRS/VM/EHR Jan. 1: For the
PQRS and VM programs, CMS begins
applying 2017 payment adjustments.
For the EHR program, CMS begins
applying 2017 payment reduction on
EPs’ claims for not meeting
meaningful use/Provider attestation
begins
HER Feb. 28: Deadline for
all participants in EHR
Incentive Programs to attest
successfully to avoid a
payment adjustment in 2018
/ EP reconsideration period
ends
EHR Jun. 30 :
Last day to
register Groups
using the CMS
Web Interface or
CAHPS for MIPS
MIPS Oct. 2:
Last start day for
a 90 day
performance
period under
MIPS
PQRS/VM/EHR
Dec. 31 : Sunset of the
VM/EHR/PQRS
programs
PQRS Jan. 3: For PQRS, 2016
submission period begins for EHR
Direct, EHR Data Submission
Vendors, Qualified Registries, and
Qualified Clinical Data Registries /
Feb. 28: QDRA submission period
closes / Mar. 31: QCDR and
Registry XML submission closes
PQRS Jan.- Dec: For
PQRS, 2016 submission
period begins for Web
Interface / March 17: Web
Interface submission
period closes
HER Mar. 28: Deadline
for appeal filing for eCQM
reporting/eligibility/faile d
reporting to the EHR
incentive programs is
within 30 days after
attestation deadline
PQRS Fall: PY2016
PQRS feedback
reports available / Fall
2017: PQRS and VM
Informal Review
periods based on
2016 performance
MIPS Jan.:
MIPS Data
Submission
begins
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4. If you participated in PQRS, Value Modifier and the EHR Incentive
Programs, you’ll have the advantage of familiarity in MIPS.
MIPS expands on the existing PQRS quality reporting methods, such as
registry, EHR, and QCDR, to allow for reporting measures across the
MIPS categories of Quality, Advancing Care Information, and
Improvement Activities.
The Cost category is claims-based and doesn’t require clinicians to
separately report cost information.
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MIPS Expands on PQRS Quality Reporting
Methods

5. Evidence-based and Practice-specific
Quality Data
If you decide to participate in MIPS, you will earn a performance-based
payment adjustment to your Medicare payment.
You earn the payment adjustment by demonstrating that you provided
high quality, efficient care supported by technology by sending in
information in the categories we briefly mentioned above, namely :
1. Quality
2. Cost
3. Improvement Activities
4. Advancing Care Information
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6. MIPS Flexibility
This program provides clinicians with flexibility to choose the activities and
measures that are most meaningful to their practice, and the reporting
standards align with Advanced APMs wherever possible.
Cost category will be calculated in 2017, but will not be used to determine your
payment adjustment until 2018 when CMS starts using it.
Default weights assigned to each category are based on a 100-point scale and
can be adjusted by CMS in certain circumstances:
Transition Year Weights:
60% Quality
15% Improvement Activities
25% Advancing Care Information
0% Cost 6

7. Choose Six from Roughly 300 Quality
Measures
The Quality Measures outlined by CMS will replace PQRS and the
Quality Portion of the Value Modifiers.
This is one of the categories that provides for an easier transition due to
familiarity and similarity to the current measures.
Providers select six of about 300 quality measures (minimum of 90 days
to be eligible for maximum payment adjustment).
One quality measure must be:
• Outcome measure or High-priority measure — defined as outcome measure,
appropriate use measure, patient experience, patient safety, efficiency measures, or
care coordination
• May also select specialty-specific set of measures
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8. Different requirements apply for groups reporting through a CMS Web Interface or
those in MIPS APM.
For the Readmission measure for group submissions that have ≥ 16 clinicians and a
sufficient number of cases there is no requirement to submit.
To determine what Quality Measures to report go to the Quality Measures page at
https://www.cms.gov and follow these CMS instructions:
1. Review and select measures that best fit your practice.
2. Add up to 6 measures from the list, including one outcome measure. You can search
capabilities at CMS to help find the measures that meet your specialty needs.
3. If an outcome measure applicable to your practice isn’t available, chose another high
priority measure.
4. Download a CSV file of the measures you have selected for your records.
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Choose Six from Roughly 300 Quality
Measures

9. Clinical Practice Improvement Activities is a
New Category for Quality Reporting
This category allows the provider to attest to
participation in activities that improve clinical
practice. Examples include:
Clinicians choose from over 90 activities under nine
subcategories:
• Shared decision making 1. Expanded practice access
• Patient safety 2. Population management
• Coordinating care, and 3. Care coordination
• Increasing access 4. Beneficiary engagement
5. Patient safety and practice assessment
6. Participation in an APM
7. Achieving Health Equity
8. Integrating Behavioral and Mental Health
9. Emergency Preparedness and Response
CMS will consider other clinical practice improvement activities in future updates to the MDP. 9

10. For Comprehensive MACRA Coverage
To learn more about MIPS and MACRA—and to stay on track for optimum
reimbursement with strategies to avoid payment cuts in the coming years—pick up
your copy of Guidebook to Medicare Access and CHIP Reauthorization Act of 2015.
About The Coding Institute
TCI is dedicated to offering quality products and services to help healthcare
organizations succeed. We are primarily focused on providing specialty-specific
content, code sets, continuing education opportunities, consulting services, and a
supportive community of healthcare professionals and experts. For more information,
visit TCI at: http://www.codinginstitute.com/about-us.
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