Issue link: http://viewer.e-digitaledition.com/i/531147
F INALLY, AFTER YEARS of applying Band-Aids to the flawed Medicare reimbursement formula, on April 14, Congress repealed the formula and replaced it with a 0.5 percent annual increase from the 2015 effective date through 2019. The 2019 reimbursement levels will remain in effect through 2025. Beginning in 2026, fees will increase by 0.75 percent for providers who participate in an alternative payment model and 0.25 percent for those who do not. The legislation included the addition of the Merit-Based Incentive Payment System (MIPS), which combines the Patient Quality Reporting System, EHR Meaningful Use and the Value-Based Modifier Program and adds a new component called Clinical Practice Improvement Activities into one reporting system. MIPS will begin in 2019 and will apply to a broad range of providers who do not participate in an alternative payment model. Those providers will be rewarded or penalized based on an overall composite score based on the above measures. Provider scores between zero and 100 will be compared to national composite scores. Initially, the negative payment adjustment for low composite scores will be capped at 4 percent. Incentive payments will extend to a maximum of three times the annual negative payment cap (initially up to 12 percent). Providers not participating in advanced payment models will be required to report on these measures if they are not currently doing so. Providers who participate in alternative payment models can receive extra payments, including shared savings for ACOs or patient-centered medical homes and care management fees. A 5 percent bonus will be available annually from 2019 through 2024 for those who receive a substantial portion of their revenues through advanced payment models. The legislation also precludes medical liability cases from using Medicare quality program standards and measures as a standard of duty of care. Technical support will be provided to help smaller practices participate in alternative payment models. For now, Medicare is retaining its fee-for-service payment model with participation in advance payment models remaining voluntary. Not included in this legislation, but a looming requirement, is Meaningful Use Stage 3. Providers are required to meet Stage 3 require- ments by 2018 or they will be subject to a 4 percent payment reduction. This requirement applies regardless of any prior participation in the EHR incentive program. In addition to the requirements of Stages 1 and 2, Stage 3 adds requirements including: + Providers must use computerized physician order entry of more than 80 percent of medication orders and more than 60 percent of laboratory and radiology orders. + Fifty percent of outpatient encounters must be at locations with certified EHR technology. + Eighty percent of patients must be given the ability to view online, download and transmit their PHI within four days of the information being available to the eligible provider. + Providers must collect and enter into EHR patient-generated health data or data from a non-clinical setting from at least 15 percent of patients. Martha S. Bethea is a CPA and the Managing Director in charge of the Medical Practice Management Group of CBIZ MHM, LLC, an independent accounting firm in Akron, Ohio. ■ Wha No? +++++++++++++++++++++++++ + +++ + +++ +++++++++++++++++++++++++ MEDICARE UPDATE ❯ By Martha S. Bethea, CPA Medicare SGR Repeal — 3 2 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ J U LY/AU G U S T 2 0 1 5