MACRA Resource Center

Find the tools and resources you need to help you understand and implement MIPS or APMs

  • Overview
  • MIPS explained
  • APMs
  • MIPS tools
  • Practice scenarios
  • Help and FAQs

Tab 1


What is MACRA? The 2015 Medicare Access and Chip Reauthorization Act (MACRA) repealed the sustainable growth rate formula, or SGR, which had been the basis for determining annual updates to the Medicare fee schedule. MACRA guarantees a positive annual update of 0.5% until 2019 and set goals to move Medicare payment from volume to value. Looking to simply avoid the penalty? Learn how.

Who is eligible to participate? The following professionals who bill Medicare more than $90,000 annually OR provide care for more than 200 Medicare patients per year are eligible to participate:
  • Physician (including doctor of medicine, doctor of osteopathy, osteopathic practitioner, doctor of dental surgery, doctor of dental medicine, doctor of podiatric medicine, doctor of optometry, and chiropractor)
  • Physician assistant
  • Nurse practitioner
  • Clinical nurse specialist
  • Certified registered nurse anesthetist
Who is exempt from 2018 MIPS participation?  You are exempt from participation in MIPS if any of the following are true:
  • You have ≤$90,000 in Medicare Part B allowed charges per year.
  • You see ≤200 Medicare patients per year.
  • This is your first year as a Medicare participating provider.
  • If you qualify for an extreme/uncontrollable circumstance as outlined by CMS.
              
 Determine whether you are eligible to participate by visiting the Quality Payment Program website and entering your NPI. 


For all MACRA participants, there are two pathways to choose from: MIPS and APMs. Most dermatologists will participate in MIPS. 

  1.  4.MIPs.pngMerit-based Incentive Payment System (MIPS) combines existing Medicare reporting requirements into a single entity that ties fee-for-service payment to performance using an overall physician quality score. Beginning in 2019 it will replace payment cuts associated with PQRS, meaningful use, and the value-based modifier with the potential to earn a bonus or incur a penalty depending on your performance score. Learn more about MIPS.

  2. 5.APMs.pngAdvanced Alternative Payment Models (APMs) reward physicians who are participating in payment models that attempt to incentivize health care decision-making based on quality, outcomes, and cost savings. Beginning in 2019 until 2024 doctors participating in Advanced APMs will receive a lump sum bonus payment of 5% of their Medicare charges. Learn more about APMs.

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Principles of Documentation for Dermatology

Ensure your documentation meets payer regulations and supports the CPT® and ICD-10-CM codes you have reported, and and helps keep quality measures score intact.

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Coding Ultimate Pack

Get the entire collection of AADA and AMA coding resources in one convenient pack. You’ll receive the latest CPT® and ICD-10-CM codes and guidelines.

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Coding Value Pack

Every dermatology practice needs these three must-have AADA and AMA coding resources to accurately code and submit claims in 2019.

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Coding Deluxe Pack

Four essential AADA and AMA manuals plus our popular 2019 Coding & Practice Updates for 2019 Live Webinar. Everything your practice needs for CPT® and ICD-10-CM updates for 2019 in order to document correctly and support your claims.

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2019 Coding Webinar All-Access Pass

Stay up-to-date on the latest 2019 coding and billing practices! Get unlimited access to seven webinars at one great price.

pre_auth_hotline_icon.pngNeed help? Call the Academy's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.

Tab 2

MIPS-timeline-Infographic.jpgMIPS will be the most likely pathway for dermatologists to participate in MACRA. Beginning in 2019, physicians will have the potential to earn a bonus or incur a penalty based on an overall MIPS performance score. 

Download a PDF with all of your reporting options for both large and small practices.

Avoiding a penalty

To only avoid the penalty (for practices of <16 providers) you must score at least 15 points. Report ONE of the following for any time period:

*The AAD strongly recommends practices report more than one time as an insurance policy in the event of submission issues or inaccuracies. Failure to correctly report in 2018 will result in a 5% penalty in 2020.

 
This video from the February 2018 issue
of Dermatology World explains how to avoid
a 5% penalty and qualify for bonuses.

Getting a small incentive (less than 0.5%)

To get a small incentive (for practices with <16 providers), you must score between 15 and 70 points. Report ONE of the following:

  • At least two quality measures on all of your eligible patients (for the full year)
  • Five required measures making up the base score of the promoting interoperability (PI) category PLUS integration with DataDerm PLUS at least one performance measure (for at least 90 days)
  • Two quality measures at least one time each AND one high-weighted improvement activity (for at least 90 days)
  • Five required measures making up the base score of the promoting interoperability category PLUS integration with DataDerm AND one high-weighted improvement activity (for at least 90 days)

Getting the maximum incentive (5%)

To get the maximum incentive (for practices with <16 providers), you must score over 70 points. Report ALL of the following for the full year:

If you do not have an EHR, you are still eligible for the maximum incentive. You first must apply for a hardship exemption and get approval, and then your quality score will be re-weighted to 75 points. 

Please note there are additional requirements for practices with more than 15 providers. Contact AAD PMC Staff for questions at MACRA@aad.org


MIPS metrics 

To calculate your MIPS score, CMS will evaluate your performance in four core areas that will be weighted. CMS has indicated the weights below for 2018, but these will adjust as the program evolves. The minimum performance threshold is 15 points to avoid the 5% penalty. To receive an incentive of 5%, you must score 70 points or more. Note: this information is for practices of 15 or fewer. providers. Please contact staff at MACRA@aad.org for information about practices of 16 or more providers. 

Core areas Quality reporting Promoting interoperability (PI) Improvement activities (IA) Cost 
Description  Clinicians choose quality measures to report to CMS that best reflect their practice. Learn more about quality scoring. This category assigns credit for use of a certified EHR and reporting of EHR-specific measures. Learn more about PI scoring. This category is rewards innovation and improvement activities that center around things such as care coordination, engaging beneficiaries, patient safety, expanding patient access, and population management. Learn more about IA scoring. The Cost category is new for 2018 and will be assessed from your Medicare Spending per Beneficiary (MSPB). 
Max points  50 points 155 points possible, but capped at 100 points  20 points  10 points 
Category weight  50% of overall MIPS score  25% of overall MIPS score  15% of overall MIPS score  10% of overall MIPS score 
Former program  Physician Quality Reporting System (PQRS) EHR Incentive Program (meaningful use)  New category  Value-based modifier 
Performance period  1 year (365 days) / starting Jan. 1- Dec. 31, 2018  90-day minimum between Jan. 1-Oct. 2, 2018  90-day minimum between Jan. 1-Oct. 2, 2018  1 year (365 days) / starting Jan. 1-Dec. 31, 2018. 
Reporting method(s) 

Individual 

  • Registry (such as DataDerm)
  • EHR
  • Claims (only small subset of measures)

Individual

  • Registry (such as DataDerm)
  • EHR
  • Attestation via CMS portal

Individual

  • Registry (such as DataDerm)
  • EHR
  • Attestation via CMS portal
CMS will calculate score based on claims data. No action needed by providers. 

Group

  • Registry (such as DataDerm)
  • EHR
  • CMS web interface (groups of >25 eligible clinicians)
  • Claims (only small subset of measures)

Group

  • Registry (such as DataDerm)
  • EHR
  • CMS web interface (groups of >25 eligible clinicians)
  • Attestation via CMS portal

Group

  • Registry (such as DataDerm)
  • EHR
  • CMS web interface (groups of >25 eligible clinicians)
  • Attestation via CMS portal
Requirements 
  • Case minimum: quality measures must meet the 20-case min for incentive
  • Data completeness: Measures must contain at least 60% of all EC patients across ALL payers for incentive
  • 2014 or 2015 certified EHR
  • Base score minimum: Must perform base score measures on at least one patient to quality for additional points in this category
Groups with <16 providers may attest to 2 medium-weighted IA for 90 days (minimum) or 1 high-weighted IA for full credit  Clinicians will receive a score for their performance. No additional data submission is required. 
Scoring 

10 points possible per measure

  • 3 points per measure for submitting data for practices ≤ 15 providers
  • Topped out measures only earn 7 points maximum
  • Earn more points depending on benchmarks
  • Base score (50 pts max required)
  • Performance score (90 pts max available)
  • Bonus score (15 pts max available)
  • 10 points per medium-weighted activity
  • 20 points per high-weighted activity
  • 20 points max possible
CMS will calculate based on claims data. No action needed by providers. 
Final score calculation 

(Total points earned on 6 measures) + (Bonus points) / Total points possible (50)

(Base + Performance + Bonus scores) / Total points possible (capped at 100)  Total points earned / Total points possible (20) 
Additional information 
  • 5 bonus points for small practices (<16 providers)
  • 2 bonus points for each additional outcome measure
  • 1 bonus point for each additional high-priority measure
  • 1 bonus point for each measure submitted via EHR integration w/DataDerm
10 bonus points for EHR integration with DataDerm  If you report as a group, only one member of the group has to meet this category for the group to receive full credit.  Review your historical QRUR report to get a better idea of what your score may be. 
pre_auth_hotline_icon.pngNeed help? Call the Academy's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.

Tab 3


5.APMs.pngAdvanced APMs will initially be the pathway less traveled by dermatologists and will be most accessible to those practicing in large academic centers or large multi-specialty group settings. To qualify you must meet benchmarks for the amount of payment you receive through an Advanced APM or the number of patients in an Advanced APM that you care for. Learn more about APMs on the Quality Payment Program website.

Those who do successfully participate in this pathway will receive a 5% bonus payment from 2019-2024 and will be eligible for larger fee schedule updates beginning in 2026.

Not all APMs will be deemed Advanced APMs, and not all who participate in Advanced APMs will qualify for the bonus payment. To receive the 5% bonus payment in 2019, qualified clinicians must have at least 25% of their Medicare Part B Payments or 20% of their Medicare patient population flow through the Advanced APM.

Advanced APMs must meet the following requirements:

  • Be CMS Innovation Center models, Shared Savings Program tracks, or certain federal demonstration programs
  • Require participants to use certified EHR technology
  • Base payments for services on quality measures comparable to those in MIPS
  • Be a Medical Home Model expanded under Innovation Center authority or require participants to bear more than nominal financial risk for losses.

View a list of approved APMs.

 


 

APM_chart_CMS.png

Those who participate in an Advanced APM but do not qualify for the 5% bonus payment may still be able to forego MIPS participation; however, many clinicians will participate in both APMs and MIPS. In 2017, clinicians participating in APMs  and MIPS at the least will receive full credit in the improvement activities category.
pre_auth_hotline_icon.pngNeed help? Call the Academy's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.

Tab 4

The Academy developed a series of MIPS tools and resources to help answer questions and guide you through the Quality Payment Program (QPP). Not sure where to begin? Try the tools in the order listed below.


1. MACRA readiness checklist

Download this checklist to help you begin to prepare your practice for CMS' Quality Payment Program.
Download checklist

2. MIPS financial assessment tool

Enter your 2016 Medicare Part B reimbursements and receive an estimate of your potential maximum penalty and incentive for the 2018 reporting year. 
Access tool


3. MIPS reporting: Decision support tool

This tool will help you determine how to participate in MIPS for 2018. Answer questions about how much reporting you are willing or able to do, and the tool will present you with your options, including specifics about what and how much you need to report.
Access tool



4. Quality measures selection tool

This tool will help your practice find eligible measures based on how you report, whether via paper, EHR, or DataDerm. You will also to be able to access detailed measures information such as reporting tips, the measure specification, and more.
Find measures

  

5. MACRA community

Join an online discussion forum that allows members to ask staff experts questions about MACRA.
Ask an expert

Get all your 2018 reporting options in one place!

MIPS_smallpractice.PNG         MIPS_largepractice.PNG
 Download for practices with 15 or fewer providers        Download for practices with more than 16 providers
pre_auth_hotline_icon.pngNeed help? Call the Academy's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.

Tab 5

1

Solo practitioner (no EHR) looking to avoid a MIPS penalty

Dr. Smith is the owner and sole care provider at Smith Dermatology in Miami, where he has been in private practice for 28 years. Dr. Smith practices general dermatology, with some cosmetics. About 25% of his patients are covered by Medicare, and he receives about $330,000 in reimbursements annually from Medicare Part B.

Five years ago, he researched the cost to purchase and implement an EHR system — about $45,000. At the time, he decided that neither bonus nor penalties were enough to tackle such a costly and time-consuming project, especially considering his limited staff to help with the transition. Dr. Smith does not plan to retire in the next five to six years, although he will make a decision after learning more about future penalties incurred from not using an EHR.

Dr. Smith did, however, enroll in DataDerm, the AAD’s clinical data registry. Enrollment was easy, and with Medicare reimbursements on the precipice of major change, he wanted access to a platform that would give him the option to report in 2017 and beyond, without the high cost of EHR implementation. With insurance networks scrutinizing costs and terminating him from networks, he hoped that a dermatology-specific registry would help him prove his value to payers and policymakers.

In 2017, Smith decided to avoid the penalty for failing to report under the first year of the MIPS program. To do so, he reported the Biopsy Follow-Up quality measure on 50 percent of his applicable patients for 90 days. Reporting through DataDerm was easier than Smith had expected. However, he knows that the minimum threshold for participation has been raised for 2018. To continue to avoid the penalty, he will have to report five quality measures at least one time each.

2

Dermatology solo practice aims for moderate incentive by submitting 2 measures

Dr. Vasquez has been in solo practice in Phoenix, Arizona, for about 10 years. Working in the Valley of the Sun, she sees a high percentage of patients for skin cancer screenings and care. Her practice has grown with the area’s rising retiree population, and she now employs two PAs. Together, they bring in about $631,000 in Medicare part B reimbursements. 

At 45 years of age, Dr. Vasquez hopes to remain in practice for many years. She also expects her practice to continue to grow. As such, she realizes that she will eventually need to adopt an EHR system. She has so far managed to comply with minimum reporting requirements for MIPS, but the requirements are quickly multiplying. Dr. Vasquez knows that an EHR system will make it much easier to fulfill reporting requirements, helping her to avoid substantial penalties and perhaps even earn an increase in reimbursements. But she wants to make sure that the initial outlay of $42,000 to adopt an EHR system is a sound business investment.

3

Dermatologists in multispecialty setting, not eligible for APM track

Dr. Gupta is one of eight dermatologists in Quality Physicians Group, a multispecialty practice in Kansas City, Missouri. The group employs 80 primary care providers and 65 specialists spread over dozens of medical specialties. Quality Physicians Group gets fewer than 25% of its patients and payments through an alternative payment model (APM), and thus does not qualify for an APM-track incentive. Medicare Part B reimbursements form an important part of the group’s business, and the group’s executive committee, mindful of the need to grow revenues, votes for full participation in the MIPS program in the 2018 reporting year.

On hearing the news, Dr. Gupta takes a moment to consider his obligations. His services bring in about $300,000 dollars in Medicare Part B reimbursements, so he knows that his cooperation will be important to the group’s MIPS effort. Having previously participated in the PQRS and MU programs (now combined into the MIPS program) and the first year of MIPS with Quality Physicians, Dr. Gupta knows that the group will cover any EHR and reporting costs associated with MIPS. He also knows that under the terms of his compensation agreement, he is eligible for a bonus equal to 2% of any additional revenue generated across the dermatology section for participation in the MIPS program.

4

Group practice aims for maximum incentive

Dr. Lee and Dr. Baker are the owning partners of Dermatology Associates of Las Vegas, a thriving group practice in a growing city of some 600,000 people. Their office includes eight dermatologists—Lee, Baker, and six associates—supported by four PAs and four NPs. Together, the sixteen practitioners earn about $4,010,000 a year in Medicare part B reimbursements.

The Dermatology Associates of Las Vegas are old hands when it comes to reporting requirements. They participated in the PQRS and MU programs. In 2017, with the start of the MIPS program, they adopted an EHR system at a cost of $100,000. It was a considerable effort and expense, but it helped them to earn a modest incentive that first reporting year. 

Encouraged by this success, Baker and Lee meet to weigh their many options for the 2018 reporting year. They quickly identify two options: Continued moderate participation in MIPS to achieve a minimal incentive, or full participation to qualify for a maximum incentive.

pre_auth_hotline_icon.pngNeed help? Call the Academy's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.

Tab 6

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Need help? Call the Academy's practice support line

Speak one-on-one with an Academy expert who will help you navigate your practice issues. A complimentary member benefit for a limited time.

Call 866-503-SKIN, option 1.


Additional help options: 

MACRA FAQs

Join AAD's MACRA community

The Academy has launched an online discussion forum that allows members to ask staff experts questions about MACRA. AAD members also are encouraged to share their experiences and knowledge with their colleagues.

join the discussion

Note: If you are already logged into aad.org, join the MACRA community now, or learn more about how to use the community.