November 10-15

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ACR Convergence 2023

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Home // 2018 MACRA final rule: What’s at risk?

2018 MACRA final rule: What’s at risk?


2 minutes

Rise LogoThe Centers for Medicare and Medicaid Services (CMS) is required by law to implement a quality payment incentive program for physicians that rewards value and outcomes. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has established two pathways for reporting this performance: Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APM).

According to the 2018 MACRA final rule, if the maximum allowed charges for rheumatology were dispersed evenly amongst all eligible rheumatologists, the 2020 bonus/penalty generated by a practice’s performance can be as high or low as +/- $16,856. This means if a practice fails to report or capitalize on their full 2018 performance, they could be at risk of losing $16,856 in 2020. Although this example assumes that all practices have the same percentage of Medicare Part B patients, a 5% penalty for a practice with a 50%–60% Medicare patient mix would be absolutely devastating.

The ACR’s Rheumatology Informatics System for Effectiveness (RISE) registry established a high bar of success in 2017, the first reporting year of MIPS. One hundred percent of all users who completed a full submission met or exceeded the exceptional performance threshold for the 2017 reporting period, and 25% received a perfect score. RISE has proved to be an invaluable asset in navigating the first year of the new reimbursement program for small practice providers.

“The RISE platform made MIPS reporting virtually effortless,” said RISE participant Martin Bergman, MD. “The reports were prepared with little to no effort on my part, were easy to review and easy to send. Just as importantly, when some issues in my reporting were found (I had used an incorrect NPI to register), RISE was with me, through the entire process, to ensure that my data were properly received and properly attributed to my practice. This could not have been easier.”

RISE helps reduce reporting burdens, simplify performance tracking, and maximize payments. As a benefit for ACR/ARHP members, RISE offers you the value of reporting at no additional costs.

The reward for reporting to your full potential is significant. Let RISE help you maximize your positive payment adjustment and protect your practice from penalty while you treat your patients.