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MACRA Positioning for Plans and Providers - Key Considerations for Providers and Health Plans | ||
The Medicare
Access and CHIP Reauthorization Act of 2015 (MACRA) represents a
tectonic shift in how providers are reimbursed for the services they
provide to Medicare fee-for-service (FFS) beneficiaries. MACRA will have
a major impact on the way most providers will be reimbursed for the care
provided under Medicare Part B. MACRA permanently repeals the
Sustainable Growth Rate (SGR). Under MACRA, Part B reimbursement will be
adjusted. An eligible clinician will see his or her Medicare
reimbursement adjusted under one of the three following options:
Merit-based Incentive Payment System (MIPS); Partial qualifying
participant; or Qualifying Participant. While on the surface this may
seem like it has little to do with health plans in the commercial,
Medicare Advantage, or Medicaid space, in reality MACRA has broad and
wide-ranging implications for other payers. Furthermore, with MACRA
implementation starting on January 1, 2017, payers need to understand
how this soon-to-be implemented law will impact the market, and
providers need to understand how this soon-to-be implemented law will
impact their reimbursement. |
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