Not Complying With MACRA Will Affect Your Revenue

By Infinx
December 4, 2017

What are the MACRA Requirements in 2018?

According to a recent survey by the American Medical Association, 75 percent of physicians don’t believe they have enough information to determine how to participate in MACRA, the Medicare Access and CHIP Reauthorization Act. Not participating will affect your future revenue. Below we give an overview of the legislation and provide three easy steps you can follow to ensure that you’re in compliance this year.

Mastering Medicare Payment Reform

Passed in 2015, MACRA aims to move reimbursement closer to value-based care. Acting on MACRA requirements by the end of calendar year 2017 is essential to protect your revenue four years from now (by 2021).

The legislation set up the following statutes:

  • CMS will pay physicians for value over volume
  • Multiple programs will be streamlined under MIPS (Merit Based Incentive Payments System)
  • Bonus payments will be set up for physicians who participate in alternate payment models (APMs)

Physicians who wish to be reimbursed by CMS must document their participation in MACRA and report it by the end of 2017. Basically, payments for MIPS are based on a score that assesses data showing performance in quality, improvement activities, advancing care information and cost. When it comes to APM bonuses, CMS says that physicians who receive “25% of Medicare payments or see 20% of Medicare patients through an Advanced APM in 2017,” will earn a 5% incentive payment in 2019.

How to comply with MACRA in 2018

Physicians have until the end of 2017 to comply with MACRA in some way to avoid losing money in 2021. Despite the short time remaining, you can still employ one of these three manageable choices and be in compliance:

  1. Start slow: The Pick your Pace program allows physicians to collect performance data for one quality measure or one improvement activity at any time in 2017. You can submit your data as late as March 31, 2018.
  2. Take a small bite: This allows for physicians to choose one quality measure that is manageable to report on. This could include one chronic disease that is prevalent in the patient panel, such as heart disease or diabetes. Reporting on one metric is more manageable than trying to report on several.
  3. Choose one item: You can select one improvement activity to report on. Categories include activities that improve outcomes, manage population health management, address emergency preparedness, mental health, or health equity.

CMS has adjusted MACRA requirements to account for physicians who were affected by Hurricanes Harvey, Irma, and Maria. Hardship exception applications are available online and must be submitted by December 31, 2017.

MACRA Perceptions and RCM solutions for 2018

MACRA is perceived by many providers as another burdensome regulatory requirement that detracts from providing quality patient care. CMS has received boatloads of comments and adverse feedback on MACRA, and as a result they are preparing to ease the process for 2018. They have even published a long list of adjustments for next year’s MACRA submissions.

If your practice or hospital is looking for a solid solution to help improve your overall revenue cycle process, Infinx can help. Our pre-registration software, iBridge, conducts insurance verification, patient pay estimates, and preauthorizations. By decreasing scheduling time and increasing reimbursements, we help increase your ability to deliver care. And our teams of certified coders and expert billers ensure your claims are entered and payments are processed accurately and quickly to secure your earned revenue. Our solutions help you get back to providing quality care to your patients.

There is a lot of information available online to help physicians comply with MACRA. By employing one of the above recommended compliance steps — start small, take a small bite, or choose one item — you’ll be able to ensure you’re on the right track. That doesn’t mean it’s easy, it just means it might be a bit more manageable. And if you need an RCM solution that is scalable to meet your needs, give Infinx a call.

About the Author



Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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