Medicare Reporting Challenges to affect Independent Practices

Private practices across the US are bracing for another series of changes from the CMS (Centers for Medicare and Medicaid Services). Changes like new legislation, more inpatient codes, compliance demands, cuts to Medicare physician fee payment rates and performance-based incentives and reporting requirements will be impacting the bottom line of many private practices across the country.

Due to complex reporting requirements for the performance-based incentive program, many physicians will not be able to take advantage of MACRA (Medicare Access and CHIP Reauthorisation Act). Also, many physicians practicing in independent practices will get to see their Medicare physician fee payment rates slashed by half this year.

There are two payment structures under MACRA- Advanced Alternative Payment Models (APM) and Merit-based Incentive Payment System (MIPS). As far as the financial impact of MACRA is concerned, smaller practices will feel the maximum pinch. To avoid getting penalised and benefit fully from the Medicare Access and CHIP Reauthorisation Act, providers will have to work issues like care co-ordination and decision-making into the normal practice workflow.

In order to implement the changes brought in by the CMS, practices will be required to do an overhaul of administrative as well as patient care workflow. Considering that private practices are already overburdened by the Medicaid reporting requirements, they will require more staff, money and time to offset the impending Medicare cuts caused by MACRA.

To overcome these challenges, private practices will be required to track and understand all elements of care, including price and outcome. They will have to eliminate tedious manual tasks related to their administrative workflow by hiring experienced staff and streamlining vital business functions. Practices will also be required to take on more patients in order to reduce the financial impact.

To offset Medicare physician fee payment rate cuts, providers will have to report all required measures to be properly scored for MACRA reimbursements. This will become even more critical given the reimbursement cuts expected in 2018. It will require them to make effective use of EHR (Electronic Health Record) system and to ensure transparency in Medicare reporting.

Some private practices have started leveraging third party solutions to produce scalable care models. With ease of documentation and reporting, they are finding it easier to fulfil MACRA’s requirements. It has also enabled them to improve the patient-provider experience and reduce cost of care.