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Maximizing provider reimbursement under MACRA

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Here’s some guidance on finding the best way to maximize provider reimbursement under the Medicare Access and CHIP Reauthorization Act (MACRA),  signed into law last year.

The law  is designed, among other things, to restructure how reimbursement rates are calculated for individual doctors in the Medicare Physician Fee Schedule.

MACRA  repealed the flawed Sustainable Growth Rate formula for  Medicare payments for clinicians’ services, and established  a new framework for rewarding physicians based on “value” rather than volume.

Modern Medicine noted that “By comparing physician compliance against national averages with mandated regulations across many specifically defined quality metrics and measures, CMS hopes to reduce what it considers costly medical redundancies and improve overall patient health and safety.”

According to the legislation, all eligible providers, “including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists… shall receive annual payment increases or decreases based on their performance as measured by standards the Secretary [of Health and Human Services] shall establish according to specified criteria” from 2019 on.

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