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Monday, June 12, 2017 - RSF Health Alliance members better positioned for larger Medicare reimbursements in 2019

Legislation changing the way providers nationwide are reimbursed goes into effect this year, and members of the RSF Health Alliance are at an advantage as they try to maximize their future reimbursements under Medicare.

It’s important for providers and practice managers to understand the way future reimbursements are structured so you can maximize your potential return.

Practices’ performance in 2017 will determine the Medicare physician fee schedule payment adjustments for 2019.

The new legislation commonly is referred to as “MACRA,” which stands for Medicare Access and CHIP Re-Authorization Act.

The legislation has a number of requirements, and the Roper St. Francis Health Alliance will help its member providers with those and thereby increase the likelihood of positive reimbursement adjustments.

MACRA repealed the Sustainable Growth Rate and locked payment rates for professional services across care settings at near zero growth. MACRA also consolidated components of three programs: the EHR Incentive Program (Meaningful Use), Physician Quality Reporting System and the Physician Value-Based Payment Modifier (VM). These three programs have been consolidated into one dual track program, the Quality Payment Program (QPP).

The most common track under the new Quality Payment Program often is referred to as “MIPS,” or Merit-Based Incentive Payment System. MIPS is the default program under the QPP and evaluates Medicare Part B providers based on four categories: quality, cost, use of certified EHR technology and practice improvement activities.

As part of MIPS, providers are assigned a score from 0-100 based on performance across the four categories. Those scores are compared to a Centers for Medicare & Medicaid Services performance threshold. Non-reporting groups are given the lowest score. Providers scoring above the CMS threshold receive a bonus, and providers scoring below threshold are subject to penalty.


The Roper St. Francis Health Alliance will handle the mandatory quality reporting requirements of MIPS for all Health Alliance member groups participating in the Alliance's Medicare Shared Savings Program ACO.

All Roper St. Francis Health Alliance members participating in the Alliance's Medicare Shared Savings Program ACO automatically will receive full credit for the clinical performance improvement activities and cost categories. This special consideration, which results from participation in the Medicare Shared Savings Program, makes it easier to achieve high scores under MIPS and increases the likelihood of receiving positive reimbursement adjustments and potentially exceptional performance bonuses.

Cathryn DeLillo is a clinical integration program manager for the Roper St. Francis Health Alliance. She soon will be contacting you regarding 2017 reporting requirements. Please contact her if you have any additional questions about MIPS, MACRA or participation in the Medicare Shared Savings Program.

Click here to review the American Medical Association's MACRA education materials.

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