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MACRA 101: Advancing Care Information

Friday, October 14, 2016   (0 Comments)
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Piecing together the MACRA puzzle

The Merit-Based Incentive Payment System (MIPS), initiated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), consolidates parts of the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier and the Medicare Electronic Health Record (EHR) Incentive Program into a single program for eligible professionals. MIPS consists of four components: quality reporting, resource use, clinical practice improvement and meaningful use of certified EHR technology.

Under MIPS, the requirement to meaningfully use certified EHR technology is referred to as Advancing Care Information (ACI), which replaces the Medicare EHR Incentive Program for clinicians.

Only physicians are currently eligible to participate in the Medicare EHR Incentive Program. Under the proposed MACRA rule, the ACI component of MIPS would expand this to include nurse practitioners and physician assistants in years 1 and 2. CMS has proposed expanding the category of eligible clinicians to include physical and occupational therapists, audiologists, nurse midwives, clinical social workers and nutrition professionals after year 3. All MIPS eligible clinicians would be able to participate as individuals or as members of a group.

CMS has proposed that the ACI category account for 25 percent of the MIPS total score in the first year. The ACI score would consist of a base score and a performance score. There is also the possibility of a one-point bonus.

Under the proposed rule, eligible clinicians would begin reporting on the ACI objectives and measures in 2017 with payments adjusted in 2019. In 2017 clinicians would have three options:

  • Use 2014 edition certified technology and report on the eight modified Stage 2 measures
  • Use a combination of 2014 and 2015 edition certified technology and report on the modified Stage 2 measures or Stage 3 measures (if their technology permits)
  • Use 2015 edition certified technology and report on the Stage 3 measures

Beginning in 2018, clinicians would need to use 2015 edition certified technology and report on the six Stage 3 measures.

In addition to the ACI component of MIPS, CMS has proposed two additional requirements for clinicians: cooperation with the government’s health IT surveillance activities and certification that they are not engaged in information blocking.

Under the proposed rule, CMS would require that clinicians agreed to cooperate with any activities conducted by the Office of the National Coordinator (ONC) for Health IT pertaining to health IT surveillance and oversight activities regarding the performance of the certified EHR technology capabilities in use by the clinician. These surveillance and oversight activities would include responding to requests for information from ONC or their authorized agents’ inquiries in a timely manner.

The proposed rule also would require that clinicians attest that they have not knowingly and willfully taken action (such as to disable certain functionalities) to limit or restrict the compatibility or interoperability of certified EHR technology.

Learn more about the ACI program on

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