Medicare New Payment System – First Quarter

The Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA, is the most immediate challenge faced by healthcare professionals and organizations. MACRA as explained in previous articles combines a number of quality measures into one single program. MACRA also calculates reimbursements to providers based on a score given in accordance with these quality measures.


The key things to keep in mind are:

  1. MACRA measurement collections started Jan 1, 2017;
  2. MACRA doesn’t apply to all healthcare Providers and Organizations;
  3. There are many variables that require action from Providers and Organizations;
  4. Failure to act will result in a loss of revenue for Qualified Providers;
  5. In the near future Medicare will expand the number of Qualified Providers.

We at Taino Consultants have been attempting to provide timely guidance and instruction to all Qualified Providers but the complexity of this particular issue makes it challenging to cover every area for all specialties so instead of looking at everything at once we will change our strategy and try to look at it in terms of blocks which roughly represents three months at a time.

For example, for the first quarter of the year you should have had:

  • See if you fall under the “Qualified Provider” category.

If in doubt follow the link below:

  • Even if you are a Qualified Provider check to see if any of the exemptions apply to you:

1. First year of Medicare Part B participation
2. Volume threshold

i.      Billing charges below $10,000
ii.      Less than 100 Medicare patients in a year
iii.      Participant in an Advanced Payment Model (APM)

  • Most Providers fall under the Merit-Based Incentive Payment System (MIPS) model but verify if MIPS or APM is for you;
  • Review last year’s performance and compare with the first quarter of the year.
  • Ensure you completed your HIPAA Security Risk Assessment and complete your attestation before Mar 16.

As mentioned before the options are many but you are not alone. Establish a baseline, decide what path to take and ask for assistance if you have questions.