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MACRA, which was passed in 2015, is the acronym for Medicare Access and CHIP Reauthorization Act. MACRA was designed to be a better way to set provider fees for services covered by Medicare and Medicaid. It was intended to safeguard physicians from decreases in fees and, in fact, created an increase for the first 5 years. After almost 2 years since this legislation was passed, it is questioned whether MACRA is any better than the old system. Truly, it is better some numbers show before MACRA payments only increased by 3% while inflation and costs rose around 60% for treatment and care. Let’s take a look at some of the pros and cons of MACRA.

The benefits of MACRA

  • Set increase. MACRA was set up with a .5 increase each year for the first 5 years in physician fees to be paid by the CMS.
  • Eliminates the SGR. The Sustainable Growth Formula or SGR was burdensome and inconsistent. Because this reimbursement set up was so hard to navigate, it was actually making Medicare almost impossible to sustain. It decreased payment to physicians and made care for patients difficult to receive.
  • Emphasizes patient care. With data showing patient improvement, the payments from Medicare are intended to increase.

The downside to MACRA

  • Pressure to perform. MIPS or Merit Based Incentive Pay includes incentives for multiple areas of data reporting positive patient outcomes and treatments. It’s a complex system involving PQRS and ACI data.
  • Small practices could take a hit. With MACRA involving multiple years to institute each layer as new regulations take place in 2019 some smaller practices could end up falling short of funds needed to keep open.
  • Advanced Alternative Payment Model at first glance may seem like a better way to go than MIPS, but, it could end up costing caregivers if patient outcomes don’t meet set guidelines.

For help with MACRA regulations and collecting Medicare reimbursements contact R-C Healthcare Management.

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