Re-Evaluating the Role of RCM for MACRA Success

It’s hard to believe we’re already well into the latter half of the first Medicare Access and CHIP Reauthorization Act (MACRA) reporting year. With the clock ticking, pressure continues to mount for physician organizations to close the inaugural year with strong momentum before 2018. Although CMS recently proposed several changes that may make Year 2 of the MACRA Quality Payment Program (QPP) less challenging for some providers, it could be more demanding for other organizations.

For Year 1, healthcare leaders identified “revising data management/reporting mechanisms to meet new reporting requirements” as the top QPP challenge within the fifth annual Healthcare IT Industry Outlook Survey. That difficulty is unlikely to change for 2018. Because the QPP ties provider reimbursement incentives to care quality, improvement activities, costs and electronic health record (EHR) utilization, alignment has been critical this year, but will be especially crucial moving into 2018. Given that, what opportunities can the revenue cycle management (RCM) team take advantage of to improve their MACRA performance for the remainder of this year into next?

Assembling the Right Team

Traditionally, provider organizations have focused reporting needs on claims and reimbursement data, working within separate data silos, disconnected from associated facilities. In the transition to value-based care, they're finding it more imperative to work cohesively across three key resource groups to access and obtain the right data for MACRA needed to attain positive or even neutral adjustments to reimbursement.

Providers need to form a strategic cross-disciplinary team including representation from financial, clinical and operational IT departments to maximize access to the right data across the patient-care continuum. Considering the two reporting paths, either Advanced Alternative Payment Models (APMs) or Merit-based Incentive Payment System (MIPS), the revenue cycle representatives on the committee can offer key insights into program measure selection.

In fact, RCM representation is so critical that one might argue that successful MACRA strategy cannot move forward without it. This financial team offers specific insight into which MACRA measures to select, by tapping into their knowledge of values and performance from past physician incentive reporting programs. For example, historical data from the Physician Quality Reporting Program (PQRS) and the Value Based Payment Modifier (VBPM) can point to which measures offer the highest potential for positive reimbursement adjustments. The QPP provides options of measures to report within each category, and the right scoring criteria can make a big difference in reporting success.

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MACRA, RCM, Revenue Cycle Management

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