Final MACRA Rule Expands Exemptions, Flexibility

Nearly a third of physicians could be exempt from Medicare’s new merit-based incentive payment system under a final rule CMS issued on October 14, 2016, for implementing the Medicare Access and CHIP Reauthorization Act (MACRA).

CMS heeded the concerns of small practices and Congress about the framework’s impact on small practices and broadened its exclusion for providers who treat a low volume of Medicare patients from MIPS.CMS said it would provide $100 million in technical assistance to clinicians participating in MIPS who are in small practices, rural areas, and in areas with a shortage of health professionals.

To help ease the impact on small providers, CMS will exempt physician practices with less than $30,000 in Medicare charges or fewer than 100 unique Medicare patients per year. The draft rule set the threshold at $10,000 a year.

The final regulations also answer requests for lower minimum reporting thresholds. CMS originally wanted providers to report quality measures on 90% of their patients from all payers, and 80% of Medicare patients. Small providers argued they would have a harder time obtaining the information technology and data needed to meet that requirement. The final rule drops the Medicare threshold to 50%.

CMS also said it was expanding opportunities to participate in programs that qualify as “advanced alternative payment models” under the law. Practices with a significant portion of their revenue under such a model are exempt from MIPS and qualify for larger rate increases and bonuses.