MACRA in a Nutshell


A provider’s fee schedule will be based on their composite score.

Penalties take effect in 2019 but are based on actions taken in 2017.

There are three exceptions.  They are:
1.    Physicians billing less than or equal to $30,000 in charges to Medicare for 100 or fewer patients
2.    Physicians in their first year of enrollment
3.    Physicians participating in APMs

For 2017 & 2018 Requirements are for  Physicians (MD/DO and DMD/DDS), Physician Assistants, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists

In 2019 it is expanded to include physical and occupational therapists, speech-language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, and dietitians/nutritional professionals

So mental health, physical therapy, audiologists, and a few others are not affected until 2019

There are 4 performance categories:
1.    PQRS  –  60%
2.    EHR  –  25%
3.    Clinical Practice Improvement  – 15%
4.    Resource Use  –  0%  (not used in 2017, but will be in 2018 and on)
This means that a huge 85% of the score is based on PQRS and EHR.

#1 Marketing Idea for Today

Marketing is the hardest part of starting or growing your medical billing business.  We are often asked for suggestions on marketing from billing services.   There are many changes in the medical billing field that are opportunities for marketing your business.  Right now we have a great suggestion for you.

Many times there is a change or new information in the field of medical billing that is important to providers but they may not be aware of.  When such information is available, it can be a great marketing tool.  And right now we do have such information available that you can use to grow your business.

I know you probably have heard a lot about MACRA, but the surprising fact is that many providers’ offices have not yet understood how this is going to affect their income in the next few years.  Not only will their income be affected but they will be scored by Medicare and their score will be published on a website.

Here’s how to use this information to market:

First of all you need to totally understand MACRA so you can explain it to a doctor.  You need to know specifically how it will affect their income.  You need to know which medical providers will be affected when.  Also many doctors will be concerned about how they are being scored when it is available for anyone to look at on a website.   For more information on understanding MACRA, see our article MACRA in a Nutshell.

Once you are confident that you understand the information, you can build a marketing campaign by calling, writing, or dropping in offices.  If you decide to go directly to offices to try to talk to them, you may find it difficult to find a decision maker who can stop to talk to you.  Be prepared by having written information you can leave behind explaining how you can help them understand this information.  Make sure to leave your contact information.   As with any marketing campaign make sure to keep track of everything.

Another idea is to offer a luncheon to cover this important information.  Either send out invitations that are enticing with the information they will be receiving or advertise what you are offering.

You could also offer to come in to do an analysis of how MACRA will impact their office.  This may seem difficult but it really isn’t.  You just need to find out:

1. Do they report PQRS?

2. Do they demonstrate Meaningful Use? Those are the two biggest areas for scoring.

If they are already doing both of those then their score should be pretty good.  If not, then you can give them information on how to fix that.

The problem with MACRA is that most providers see “2019” and think, “We don’t have to worry about anything yet”.  But the reality is that the 2019 income will be determined but what the providers do in 2017.  Ignoring MACRA is not an option.

So back to marketing, you can use MACRA to get the provider’s attention.  Design a flyer or other informational packet and use it to get your foot in the door.  Once in, you may discover other areas that are problems and will have the opportunity to talk to them about your services.