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Starting in October 2015, the transition to ICD-10 coding requirements profoundly changed the billing and reimbursement landscape for healthcare providers.
At the same time, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) implemented the new coding requirements and in turn encouraged chiropractic clinics to use electronic health record (EHR) systems. As chiropractors learned the new coding system, many of them also began implementing EHR software and making other technology and workflow changes.
Although you might not be familiar with MACRA, this law has numerous implications for chiropractic care—some of which may fundamentally change the way you work. For example, a little-known aspect of MACRA revises the reimbursement model Medicare uses to pay providers.
The MACRA model
“Under MACRA, solo practitioners will be required to meet certain quality care criteria,” says Ted Arkfeld, DC, of Arkfeld Compliance, LLC. “There are also meaningful use requirements for EHR that are wrapped up in quality reporting requirements.”
Some of the MACRA reporting requirements are due to begin in 2017. Chiropractors billing Medicare will be tracked according to various quality care metrics. These metrics will be used to determine additional merit-based incentive payments for top performers—and also fines for doctors who are lagging behind on these metrics.
“There’s going to be criteria for clinical improvement, for clinical quality and, among other things, criteria for a certified EHR,” Arkfeld says.
The MACRA Quality Payment Program (MACRA QPP) is a new payment system with two distinct models—the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Models (APMs). Both systems have similar quality standards. MIPS is a key part of this scheme, bringing together pieces of the Physician Quality Reporting System (PQRS), the Value Modifier (VM), and the Medicare electronic health record (EHR) incentive program into a single framework. The Medicare Sustainable Growth Rate (SGR) method is eliminated and no longer used to calculate payments.¹
The Centers for Medicare and Medicaid Services (CMS) list four measurements used by MIPS.¹
- Resource use
- Clinical practice improvement
- Meaningful use of certified EHR technology
APMs are different payment systems that allow Medicare and Medicaid to adapt to different care and payment models such as Accountable Care Organizations (ACOs), Patient-Centered Medical Homes (PCMHs), and bundled payment models. Some health providers will be eligible under this program for lump-sum incentive payments from 2019 to 2024. Beginning in 2026, some providers will receive higher annual payments.¹
Even chiropractors who primarily bill other insurance plans should be prepared for these changes, Arkfeld suggests. He says that, in time, insurance companies typically follow Medicare and Medicaid’s lead—after MACRA provisions start taking effect in 2017, major insurance companies may begin to follow suit.
“Well, you may not see many Medicare patients, but I guarantee you that the other insurance companies are going to follow this methodology,” says Arkfeld. “It’s not just going to be for Medicare.”
To prepare for MACRA requirements, you can begin working on improvements in the quality metrics measured by MACRA QPP. Clinics should also ensure that they have a certified EHR system. EHR software is certified by the Office of the National Coordinator for Health Information Technology (ONC). The ONC maintains a product list of certified health IT software online.²
Certified software is available in server-based systems and some can be accessed through a cloud-based system. Cloud-hosted EHR, maintained remotely and typically updated on a continuous basis, is becoming increasingly popular. This type of EHR is accessed using office computers but is hosted off-site by the vendor.
Numerous cloud-hosted systems offer certified EHR that meets MACRA requirements. These systems can be used away from the office and still provide access to necessary data.
“As a sports-centered chiropractor, the versatility, speed, and comprehensive character of cloud-based software is imperative for those doctors working on location at a sporting event,” says Spencer Baron, DC, a team chiropractic physician for the Miami Dolphins.
Baron says that he chose a cloud-based system after researching a range of different certified EHR options. The cost, convenience, combination of features, and ease of use of this type of EHR program ultimately helped him decide to implement his current system.
Where to learn more
CMS offers more information about MACRA and MACRA QPP online at their website. Detailed, complete information from CMS is available in their recently published document, CMS Quality Measure Development Plan.
Medicfusion, a subsidiary of VSS Medical Technologies, Inc. is a certified EHR for Chiropractors. Since its inception in 2002, Medicfusion has been focused on providing a certified EHR to professionals seeking an easy-to-use paperless system with superior customer support. Medicfusion has an extensive range of features including automated workflows, patient web portal, electronic prescribing, electronic payments, clinical documentation (SOAP notes), comprehensive reporting, online training resources, etc.
On November 11, 2015, Medicfusion EHR achieved Office of the National Coordinator for Health Information Technology (ONC-HIT) 2014 Edition Complete Certification via Drummond Group, an Authorized Certification Body (ACB) that has been empowered to test software for compliance with the requirements of the federal government’s program. This stamp of approval designates that the software offers functionality that enables eligible providers and hospitals to meet Stage 1 and Stage 2 Meaningful Use requirements, qualifying these organizations to receive payments under the ongoing EHR adoption program.
¹ CMS.gov. “Quality Payment Program: Delivery System Reform, Medicare Payment Reform, & MACRA.” Centers for Medicare & Medicaid Services. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html. Accessed May 2016.
² HealthIT.gov. “About the ONC Health IT Certification Program.” HealthIT.gov. https://www.healthit.gov/policy-researchers-implementers/about-onc-health-it-certification-program. Published April 2016. Accessed May 2016.