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

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  MACRA_intro_video_screenshot.PNG
             Get a quick overview of MACRA. View now.

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 The 2015 Medicare Access and Chip Reauthorization Act (MACRA) repealed the sustainable growth rate formula, or SGR, which had been the basis for determining annual updates to the Medicare fee schedule.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 guaranteed a positive annual update of .5% until 2019 and set goals to move Medicare payment from volume to value. 

Who is eligible to participate? The following professional 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

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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Be MACRA Ready Webinar

Are you MACRA ready? Join the AAD Expert Physicians to learn how the MACRA final rule impacts you.

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AAD-AMA Coding Packs

Rely on the AAD for the most authoritative coding resources for dermatologists. Packages include AAD's new Principles of Documentation for Dermatology.

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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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MIPS and its Impact on Coding & Documentation Webinar

Join the AADA Coding Experts and learn how MIPS and coding updates for 2018 directly impact you.

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2018 Coding Webinar All-Access Pass

Stay up-to-date on the latest 2018 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.

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MIPS 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. 

Avoiding a penalty

To only avoid the penalty (for practices of fewer than16 providers) you must score at least 15 points. Report ONE of the following for any time period:

  • Five quality measures at least one time each*
  • One high-weighted improvement activity
  • Five required measures making up the base score of the advancing care information (ACI) category PLUS integration with DataDerm

*The AAD strongly recommends practices report more than one measure or report at least one measure over a 90-day period as an insurance policy in the event of submission issues or inaccuracies. Failure to correctly report one measure or activity in 2017 will result in a 4% penalty in 2019.

Getting a small incentive (less than 0.5%)

To get a small incentive (for practices with fewer than 16 providers), you must score between 15 and 70 points. Report ONE of the following for 90 days:

  • At least two quality measures on all of your eligible patients
  • Five required measures making up the base score of the advancing care information (ACI) category PLUS integration with DataDerm PLUS at least one performance measure
  • One of the above PLUS one high-weighted improvement activity

Getting the maximum incentive (5%)

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

  • Six quality measures on all of your eligible patients
  • One high-weighted improvement activity
  • Five required measures making up the base score of the ACI category.

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. Scores in each area will be weighted. CMS has indicated the weights below for 2017 but will adjust these as the program evolves.

7a.QualityReporting.pngQuality Reporting, 60%: This category evolves the PQRS requirements. You must report only 6 measures, rather than the 9 required under PQRS. Of the 6, one must be an outcome measure or high-priority measure. You must report measures for 50% of your population regardless of payer. Reporting may be completed via a registry such as DataDerm, your EHR, or claims. You will receive 3 - 10 points for each measure based on how your performance compares to the benchmark. You can select any 6 measures or pick from the dermatology specialty measure set.

7b.AdvancingCare-Info.pngAdvancing Care Information, 25%:  This category assigns credit for your use of a certified EHR and replaces the requirements of the current meaningful use program. You will receive an overall score comprised of several elements:

  • Base score: 50 points for reporting 5 required measures.
  • Performance score: 90 points for reporting 9 optional measures which assess patient interaction and health information exchange.
  • 5 Bonus points: For participation in a registry such as AAD's DataDerm.
  • 10 Bonus points for completing improvement activities related to ACI.
  • Learn more about ACI.

Required reporting may be completed via a registry like DataDerm, your EHR, or the CMS portal.

7c.ClinicalPractice-Improvement.pngImprovement Activities, 15%: A practice of 15 or fewer physicians will receive full credit for completing one high-weight activity or two medium-weight activities selected from a list of 90 activities qualified by CMS.
You can report on these activities through a data registry such as DataDerm, your EHR, or the CMS portal.


7d.-Resource-userv.pngCost, 0%:
  No reporting will be required for this category. CMS will assign your score based on claims data in 2017 and report it to you in your feedback report, but it will not account for your overall score.

CMS will develop benchmarks for each of these measures and points will be assigned based on how your score compares to the benchmark. Your overall score will be based on how you compare to others reporting the measure, which represents an evolution by CMS to pay-for-performance under MIPS from the pay-for-reporting approach of PQRS.

MIPS timeline

Your MIPS incentive in 2019 will be based on your 2017 performance. Incentives continue until 2022.
MIPS-timeline-Infographic.jpg

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.

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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.

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.

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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

After answering a few questions about your practice, you’ll know whether you need to participate in MIPS to avoid a penalty in 2019. If you are MIPS eligible, this tool will provide an estimate of the financial impact of your MIPS decision, whether you choose full reporting, partial reporting, or minimal reporting.
Access tool


3. MIPS reporting: Decision support tool

This tool will help you determine how to participate in MIPS for 2017. 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. DataDerm reporting: Decision support tool

If you plan to report using AAD’s DataDerm, use this tool to get more detailed information about DataDerm-specific reporting options. Please note that you do not need an EHR to fulfill the minimum requirements to avoid the MIPS penalty
Access tool


5. 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

  

6. MACRA community

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

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Solo practitioner aims to avoid 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 patient 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. Ultimately 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 final decision after learning more about future penalties incurred from not using an EHR.

Although he has never participated in PQRS or meaningful use programs, cutting his Medicare Part B reimbursement by 5%, Dr. Smith did enroll in DataDerm, the AAD’s clinical data registry. Enrollment was free, 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, or 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.

2

Dermatology solo practice aims to receive 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, her business relies in large part on 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 a year in Medicare part B reimbursements.

At 45 years of age, Dr. Vasquez hopes to remain in practice for many years to come. She also expects her practice to continue to grow. As such, she realizes that she will eventually need to adopt an EHR system. With the introduction of the MIPS program looming, she feels that now may be the time. Dr. Vasquez knows that an EHR system will make it much easier to fulfill MIPS 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 working 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 percent 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, vote for full participation in the MIPS program.

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 participated in the PQRS and MU programs 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 percent of any additional revenue generated across the dermatology section for participation in the MIPS program.

4

Group practice aims for maximum MIPS incentive

Dr. Lee and Dr. Baker are the owning partners of Dermatology Associates of Richmond, a thriving group practice in a growing city. Their office includes five dermatologists — Dr. Lee, Dr. Baker, and three additional associates — supported by two PAs and two NPs. Together, the nine practitioners earn about $2,255,000 a year in Medicare part B reimbursements.

In preparation to begin 2017 MIPS reporting, Drs. Baker and Lee meet to discuss their options. They quickly rule out non-participation as this option carries an estimated penalty of $90,200 for the 2017 reporting year, ballooning to $202,950 in 2020. Such a heavy loss in revenue would be difficult for their business to sustain. Recently, they have had serious discussions about adopting an EHR system. Offsetting any potential penalties under MIPS could provide the justification to spend the estimated $60,000 the system will cost.

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.