The Quick, CMS-Approved Way to Avoid a MACRA Penalty

MACRA positive or negative payment adjustment

If you’ve been trying to wrap your head around MACRA for a while, you may be at the point where you’re willing to give up hopes of a bonus if you could just be sure you won’t face penalties.

Good news: As long as you submit a little something to the Quality Payment Program, you won’t have to worry about a negative payment adjustment. Check out these reporting options, and then be sure to use the list of MACRA resources at the end to rev up your preparations. That bonus may be within your reach after all.

Know the Consequences of Your Reporting Choices

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) involves a shift to value-based payment models. The new related Quality Payment Program (QPP) has two tracks:

  • Advanced Alternative Payment Models (APMs)
  • Merit-based Incentive Payment System (MIPS).

The expectation is that most physicians will start in MIPS, which includes elements of the Physician Quality Reporting System (PQRS), the Value-Based Modifier (VM or VBM), and the Medicare Electronic Health Record incentive program (also called Meaningful Use).

CMS is offering a “Pick Your Pace” approach to MIPS. If MIPS is the program for you, the option you choose to follow in 2017 will determine the impact on your Medicare payments in 2019.

  • Don’t participate: If you don’t submit any 2017 data, expect a negative payment adjustment.
  • Submit something/test: This choice is your quick road to avoiding a penalty. You must submit some data, such as one quality measure, to avoid a downward payment adjustment. This option helps ensure that your system is working and that you’re ready to participate at a higher level in 2018 and beyond.
  • Submit a partial year: Submitting 90 days of 2017 data to Medicare will also keep you safe from a penalty and may even bring you a positive payment adjustment. This option means you can begin after Jan. 1, 2017, if you need more time to prepare.
  • Submit a full year: Submitting a full year of QPP data is your best chance for a bonus.

Add to Your Reimbursement by Getting to Know MACRA

You’ve been through changes before, and you really can manage to do it again. There are a lot of resources available to help you:

  • CMS: From CMS’s MACRA: MIPS & APMs site, you can access a QPP site. Don’t miss the Education page, which includes resources like a Where to Go for Help Fact Sheet.
  • AMA: The AMA has a MACRA site that includes an assessment tool.
  • Specialty societies: Check your specialty society for information specific to your practice. For instance ACC and AAFP have MACRA resources.
  • Webinars/Seminars: There are a variety of options available to learn about MACRA from experts, so think about what level of understanding you need to have of MIPS and APMs, and find a seminar or webinar that offers the level of training you require.
  • AAPC: AAPC offers a MACRA category in its Knowledge Center with informative articles and helpful updates.

How About You?

What track and pace are you choosing for MACRA?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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