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by Antonio Arias, MBA, CHBME

5 Timely Tips for Adjusting to MACRA


The Quality Payment Program (QPP) from CMS, which includes the Medicare Access and CHIP Reauthorization Act or ‘MACRA,’ is yet another step toward a more value- and outcome-driven healthcare environment than the traditional fee-for-service landscape.

Yet while QPP and MACRA represent a seminal shift, they also put providers in a ‘shifty’ situation. Right now, they need to balance the day-to-day considerations of their regular operations against the need to implement practices and policies to help them adapt to the new changes.

What practices and policies are those? It remains hard to say; information about MACRA has not been disseminated by CMS in any easily consumable, understandable way. As a result, many physicians remain uninformed about their requirements: As of February, only 35 percent of hospital executives surveyed by Health Catalyst reported having a strategy in place and are ready to comply with MACRA reporting.

With 2017 being the first reporting year under the new program, now is the time for doctors, practice managers, medical billing firms, and hospital administrators to get better acquainted with MACRA. Here are five quick pieces of advice.

Access Smart Resources: Knowing how little practical MACRA guidance has been made available to providers, the American College of Physicians (ACP) launched a free online tool to help physicians understand it. The Quality Payment Advisor tool uses customization to provide the information and resources that are most appropriate for an individual practice. Other free resources may be available from your medical association or any specialty-specific groups.

Prepare for the ‘Bare Minimum’: The 2017 MACRA reporting requirements are not overly onerous for physicians because the first-year stipulations have been simplified. (That is, only one quality measure needs to be reported to prevent a 4% negative payment adjustment down the road.) Use 2017 as a starter phase to get comfortable with MACRA long term.

Embrace the Benefits: MACRA compliance may be complex and challenging in practice, but it creates big-picture advantage for providers over the long run. MACRA replaces the Medicare sustainable growth rate formula – instead allowing physicians to create their own conversion rate based on their MACRA score. Difficult as the requirements may be, they ultimately give physicians greater control over their fee schedules.

Get IT Involved (Yesterday): MACRA requires a joint effort of IT and departmental resources to successfully combine clinical, financial, and operational data. If you haven’t already, engage those in your organization with the technical knowledge to extract the right data, then integrate it properly to demonstrate your satisfaction of the right criteria for your reporting paths.

Remember – it’s About Patients: ‘Quality Payments’ via the QPP are really about Quality Care. Don’t let MACRA distract from the most important area of your practice. If you focus on creating a culture of quality, providing optimal care, and also meeting the specifics of the programs, you’ll be primed for a patient-centric (and profitable) MACRA future.


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by Antonio Arias, MBA, CHBME

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