Changes in MIPS and MACRA in 2019

Changes in MIPS and MACRA in 2019

Changes in MIPS and MACRA in 2019


Healthcare facilities should be aware of changes in the requirements regarding the treatment of patients covered by Medicare and Medicaid. The (MACRA) Medicare Access and Reauthorization Act of 2015 and (MIPS), Merit-based Incentives must be followed in order for healthcare organizations to receive compensation from the Government.  MACRA require healthcare providers accepting Medicare covered patients to use an Electronic Health Record Software. The paper-based system or an outdated EHR, will need to be updated to a current EHR, in order to maximize compensation for Medicare patients.


There are changes for 2019, made to MACRA, that you and your staff will need to know, to qualify for compensation for Medicare patients.


  1. (MIPS)-Cost-category increase

Center for Medicare and Medicaid Services, (CMS) suggest that the weighting of MIPS cost category should increase from 10% to 15%, per the report from the advisory board. CMS also lowered the weighting of the quality category from 50% to 45%.  Categories, promoting interoperability and improvement activities will remain the same as last year, at 15%.


  1. (MACRA)-Expansion of low-volume thresholds

If a healthcare facility has less than $90,000 or less than 200 patients in part B allowable charges, they are excluded from MIPS requirements. Your Electronic Health Record software or billing company should update this information. Be sure to verify with your billing company. Our company, Lightspeed RCM automatically updates with all changes and is designed to maximize MACRA/MIPS compensation. Healthcare organizations should check with their billing company for this update, as it will affect your compensation.


  1. (MACRA)-0 to 10% increase for cost category weighting.

Center for Medicare and Medicaid Services, (CMS) increased the cost-category to 10% for 2019, to get Physicians started. The cost-category will account for 30% of your composite MIPS score by 2022, according to clinician Today. For an easy transition, practices should get ready for mean or median scoring. This means a decrease in the quality-category at a corresponding level.


  1. (MACRA)-Immunity for extreme and uncontrollable Circumstances.

Center for Medicare and Medicaid Services, (CMS) will exempt practices working in 2017, that were affected by natural disasters or extreme weather conditions that disrupted the health services you provide, conditions beyond their control.



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