As 2017 marches on, it’s time to once again turn our heads towards regulation. This time, it’s MACRA.
The Medicare Access and CHIP Reauthorization Act (MACRA) and the U.S. Centers for Medicare and Medicaid Services (CMS) will affect radiologists in 2017 and even further in 2019. The changes that may concern you will involve reimbursement and how those reimbursements will be handled.
MACRA and merit-based care
Medicare will eventually link a large portion of payments to radiologists based on value and quality of care. Performance assessments begin this year for payment adjustments in 2019. Lead study author Dr. Andrew Rosenkrantz stated that “[R]adiologists must start preparing now, taking actions to ensure future success with the payment program.”
Radiologists will be paid through the Merit-Based Incentive Payment System (MIPS). MIPS will control adjustments, both positive and negative, to fee-for-service payments. The main concern is that while some doctors’ performances will be based on face-to-face interaction, doctors who have limited face-to-face interaction may not be eligible.
Dr. Bibb Allen Jr. said the following.
“Using CMS’ proposed criteria for which physicians will receive special considerations, many radiologists will be deemed ineligible for these special considerations and thus be evaluated based on performance categories beyond their control.”
The American College of Radiology (ACR) communicated an alternative criteria plan that could allow for compensation for physicians who do not have as much face-to-face time as other doctors, say general practitioners.
The plan states that if CMS were to add a set of 100 or fewer codes, nearly 99 percent of radiologists would receive considerations. Patient encounters would represent just 10 percent of all billed codes among remaining radiologists. The ACR brought this plan to CMS for consideration.
According to the final rule, the CMS accepted the ACR’s proposal and modified it slightly. Under the new definition, almost 90 percent of diagnostic radiologists will be eligible for special consideration, and that number could rise to 99 percent.
In conclusion, being aware and keeping up on the changes that are going into effect this year are going to be vital for the success of your reimbursement claims and how well your practice can do.
This article was written by Mike Schwartz, a technical writer with Novarad.