The Medicare Access & CHIP Reauthorization Act, or known as MACRA, was finalized and implemented by Medicare as of January 1, 2017. Its goal is to connect Medicare fee-for-service reimbursement to quality and value. The program plans to accomplish this through two avenues. Either reporting quality measures through the new quality reporting system (MIPS), or by participating in and Advance Alternative Payment Model (Advanced APM’s).

Most providers will fall into the category of a qualified practitioner for the quality reporting system rather than the advanced APM’s. IDTF’s currently do not have to report for the quality program just as in the past with the PQRS reporting system. Each provider is liable for reporting for their quality efforts to CMS in 2017 and the results are calculated both on an individual and practice scale. This means that even though you may report successfully for yourself, the practice overall could still be liable for a penalty if enough of the eligible practitioners in the group do not report or are penalized.

With the instituting of MACRA for the 2017 service year, what was previously PQRS has now become the new quality program named MIPS. Since it is the first year of this new program, CMS is using it as a development period. If providers report one quality measure for 90 days they will avoid a penalty in Medicare reimbursement. One can accomplish this by choosing a quality measure and reporting it on your claims for your Medicare part B and Railroad Medicare patients. Some measures are burdensome for providers to report on, so we have put together a brief list of easily reportable measures that most providers that have face to face encounters with patients can accomplish via claims-based reporting, which is one limited avenue of reporting, due to only a few measures that qualify for this reporting avenue. Alternatively, the practice could elect to choose other approved reporting methods which opens up more measures that can be chosen: Qualified Registry, Qualified Clinical Registry, EHR Reporting, Registry Measure Groups, Web Portal Submission, Web Portal Survey Measures, and GPRO Reporting. Providers can also choose their reporting structure and report as individuals or a virtual group with providers from other practices. CMS has provided a resource for all the information on the measures and the structure of the program which can be found at https://qpp.cms.gov/.

Measure 226: Tobacco Use: Screening and Cessation Intervention

  • Population: All patients 18 and older with primary, secondary, or tertiary Medicare part B or RR Medicare (No Medicare HMO’s) with a visit in 2017
  • Reported once per patient per 2017 year/reporting period
  • Measure: Screened for tobacco use one or more times within 24 months AND received cessation counseling intervention if patient uses tobacco
  • Tobacco Cessation Intervention: Includes brief counseling (3 minutes or less) and/or pharmacotherapy documented
  • If tobacco status is unknown OR the patient is a tobacco user and had no intervention it will count against your quality
  • Outcomes:
    • Performance Met: Tobacco user AND received intervention = 4004F
      Current tobacco non-user = 1036F
    • Exclusion: Documentation for not screening the patient for a medical reason = 4004F + 1P modifier
    • Performance Not Met: Tobacco screening OR intervention not performed, reason not otherwise specified = 4004F + 8P modifier

 

Measure 1: Diabetes: Hemoglobin A1c(HbA1c) Poor Control (>9%)

  • Inverse Measure: “Performance Not Met” is good
  • Population: All patients age 18-75 diagnosed with Diabetes and primary, secondary, or tertiary Medicare part B or RR Medicare (No Medicare HMO’s) seen in 2017
  • Reported once per patient per 2017 year/reporting period; The most recent A1c measurement will be the one used to report this measure to CMS
  • Diabetes patients that have not had a documented A1c test with results during the measurement year (2017) will count against your quality as well as those with A1c higher than 9%
  • Outcomes:
    • Performance Not Met: Most recent A1c level is less than 7% = 3044F
      Most recent A1c level 7% to 9% = 3045F
    • Exclusion: Hospice services provided to the patient during the measurement period = G9687
    • Performance Met: Most recent A1c level is greater than 9% = 3046F
      Diabetes patient was seen in the reporting year and an A1c test was not done in the past 12 months = 3046F + 8P modifier

Measure 48: Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older

  • Population: Female Patients 65 and older with primary, secondary, or tertiary Medicare part B or RR Medicare (No Medicare HMO’s) seen in 2017
  • Reported once per patient seen during the reporting year
  • Assessment is reportable if done within the last 12 months prior to service visit
  • Outcomes:
    • Performance Met: Presence or absence of urinary incontinence assessed = 1090F
    • Exclusion: Hospice services provided to the patient during the measurement period = G9693
    • Performance Not Met: Presence or absence of urinary incontinence not assessed = 1090F + 8P Modifier

In order to avoid minimum 2% Medicare reimbursement cut providers need to report 1 quality measure for your Medicare patients for a 90 day period. We recommend providers choose a quality measure that works the best for them and work towards avoiding these penalties.