Go Back

2018 Medicare and CHIP Reauthorization Act Ruling Update

24 Dec 2017

By: Coni Westmoreland, MHA, MSPH, Value Based Care Operations Director, Salem Health Medical Group

View as a webpage  

Did you know the Medicare and CHIP Reauthorization Act ruling, otherwise known as the Quality Payment Program, received a refresh for 2018? Here’s what we think you should know about MACRA:

  • Minimum Threshold Increase
    • Providers are excluded from the regulation if they bill Medicare less than or equal to $90,000 - or - less than or equal to 200 Part B beneficiaries
    • Providers can “opt-in” to Merit-Based Incentive Payment System and gain incentives even if not required to participate
  • Gradual Implementation Continuation
    • Due to reporting hardship, CMS will allow for continued minimal data submission (90 days) data in 2018 for two measure categories:
      • Advancing care information
      • Improvement activities
    • 12 months of data is still required for quality measure reporting
    • Creates virtual groups for small provider groups that elect to report together
  • Advanced Alternative Payment Model (AAPM) Update: AAPMs now includes a new Accountable Care Organization Track, 1+.  

What you need to know about Track 1: MIPS

  • Providers are auto-enrolled in MIPs based on minimum thresholds unless they opt-into a Track 2 Advanced Alternative Payment Model.
  • Reporting must be submitted to CMS by March of each year for the prior year. Reimbursement changes will be for two years after. For example, reporting for calendar year 2017 is due in March 2018. Payment adjustment takes effect in 2019.
  • There are four reporting measure categories with the following weights for 2018:
    • Advancing care information (25%)
    • Improvement activities (15%)
    • Quality (50%)
    • Cost (10%). 
  • Payment adjustments begin at +/-4% in 2019 (2017 data), +/-5% in 2020 (2018 data).