Hospitalists are Eligible Clinicians with MACRA

Written by Liz Morgan, Senior Solutions Engineer

Regulatory-Blog-HeaderImage-Hospitalists-are-Eligible-Clinicians-2017-01.jpg

I understand hospitals are trying to digest information about hospital-based physicians based on the latest information from The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Let's take a look at the questions we need to ask. Do you need to participate in Quality Payment Program (QPP)? Do you need to participate in Merit-based Incentive Payment System (MIPS)? The answer is yes to both!

So who Isn’t Eligible?

  • Clinicians who enroll for Medicare for the first time during the MIPS performance period are exempt from reporting until the following year.
  • Clinicians who have less than or equal to $30,000 in Medicare charges or fewer than 100 Medicare part B patients per year.

Who IS Eligible?

  • Clinicians who furnish 75% or more of their professional services in POS 21, 22, and 23 or inpatient, campus outpatient hospital, or emergency room setting.

The determination for the hospital-based designation is done individually, at the individual NPI level, even if the Tax ID is choosing to submit for MIPS as a group. This is because there is no separate definition for a hospital-based group for MIPS.

Now that you have considered if your hospital-based physician is eligible, you then have to decide what you need to submit to make certain you bolster the organizational coffer or get the best chance of a 4% positive payment adjustment for 2019.

Submit for Positive Payment Adjustment

QPP has four categories

  • Quality
  • Improvement Activites
  • Advancing Care Information
  • Cost

Out of four categories, you would need to submit information for the year on Quality and Improvement Activities. For Quality, you would want to capture and report on six quality measures, including an outcome measure. You would also attest that you completed at least two Improvement activities. Advancing Care Information and Cost are items that you wouldn't need to address this year.

If this seems like too much for the transition year (2017), submitting one Improvement Activity and/or one Quality Measure to avoid a downward payment adjustment might be the best option for you.

CMS has done a significant amount of work trying to make things clear on their website. Check it out at http://qpp.cms.gov.

For more details about MACRA requirements, join us for the upcoming webinar "MACRA and Hospitalists — Are You Prepared?" on April 20, 2017 at 2pm ET and get your questions answered.

Topics: CMS, Value-based Care, Quality Management, MACRA, Quality Measures, MIPS, Eligible Clinicians

Subscribe to the Regulatory and Compliance blog.

Receive the latest articles directly in your inbox.
Enter your email address and click SUBSCRIBE:

Comments

0 COMMENTS

Just When We Think We Understand eCQMs….it all changes!

Many hospitals are gearing up to start another reporting period for electronic Clinical Quality Measures. As you may know, with proposed CMS changes released in April, the requirements were reduced...Read More

MU Stage 3: Final Rules Bring Subtle Changes

We all know that MU Stage 3 brought its fair share of confusion, including a long waiting period and delays on the final rulings. Back in November, CMS released what they called “Final, Final.” ...Read More

Hospitalists are Eligible Clinicians with MACRA

I understand hospitals are trying to digest information about hospital-based physicians based on the latest information from The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Let's...Read More

Keys for Preparing to Meet the CMS Final Rule on Disaster Preparedness

For Medicare and Medicaid participating providers and suppliers, the CMS Final Rule on Disaster Preparedness has been published. This 17-page document, plus its hundreds of pages of comments, spells...Read More

What’s new with the CHPL (Certified Health IT Product List) and Certification Surveillance?

Have you noted the changes in the CHPL? In my opinion, the changes make it easier for you, as a healthcare provider, to check for your full list of certified products, and to secure your Medicare ID...Read More

Meaningful Use Audits: It All Comes Down to Documentation: Are You Prepared?

CMS has been auditing Meaningful Use payments since 2012, and since that time, we’ve been helping our customers through the process. Our experience has proven time and time again, the better a site...Read More

CMS Extends the EHR Incentive Program Deadline to March 11

As of February 11, 2016, CMS has announced an extension to the Medicare EHR Incentive Program. For eligible hospitals and providers participating in the program, this extension should bring relief...Read More

"What's Going On, CMS?"

If you’re asking: “What the heck is going on with Meaningful Use? Is it over? Are we done?” then you’re not alone. The announcement released this week by Andy Slavett, stating that Meaningful Use...Read More

Happy eCQM Days Are Here

The 2016 IPPS final rule has been released for clinical quality measures. It now requires hospitals to report Meaningful Use clinical quality measures via an electronic submission method for 2016....Read More

NPRM Changes to Core 6.2 Patient Engagement

Staying Focused On Patient Engagement Despite Proposed NPRM Changes for 6.2 With the proposed changes for Meaningful Use Stage 2, I’m often asked for advice. One piece of advice that I offer has...Read More

Meaningful Use: Don’t Go It Alone Despite Tight Budgets

With hospital budgets shrinking and any remaining dollars being allocated in many directions, we often hear from customers that they don’t have funding for one initiative or another — and end up...Read More

Stage 3 2015 Proposed NPRM: What is CMS Thinking?

As of last September, I’ve been watching for CMS to officially announce the switch to a shorter EHR reporting period for 2015. At that time, Congress first introduced Bill H.R. 270, designed to allow...Read More

Meaningful Use Stage 3 – Lots of Questions, Few Answers

After getting through a dense reading of the NPRM for Stage 3 of Meaningful Use in one long day (all 301 pages), my goal is to help our readers look ahead and plan for Stage 3. There are several...Read More