Everything There Is To Know About MACRA and FQHC

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The Medicare Access and CHIP Reauthorization Act (MACRA) was passed by Congress in 2015, which led to the institution of the Quality Payment Program (QPP). MACRA was meant to change healthcare reimbursement models to the quality, rather than quantity of care.

Federally Qualified Health Centers (FQHC) are the most affected by this new reimbursement paradigm, especially when it comes to Medicare Part B payments. We’ll discuss FQHCs a little later in this article.

The new legislation does away with the Sustainable Growth Rate (SGR) formula which was used to determine Medicare Part B payments.

Now, there are two new payment systems: MIPS (the Merit-Based Incentive Payments System) and APMs (Alternative Payment Models).

While it seems like MACRA and FQHC come with a lot of regulations, there are some things that are simple to understand. Let’s take a closer look at FQHC and MACRA and the relationship between the two.

What is MACRA?

As we outlined earlier, MACRA stands for the Medicare Access and CHIP Reauthorization Act, and involves a payment system that affects federally qualified health centers.

This payment method comes down to a scoring system, based on the physician office’s quality level, costs, improvements in their clinic, and advance care information.

Payment adjustments kick in depending on the information an office submits, which can be both upward or downward. It’s projected that many clinics will have reductions of up to 9% by 2022.

A large number of medical personnel will be among the types of eligible clinicians for MACRA, including physicians, nurse practitioners, clinical nursing specialists, certified registered nurse anesthetists and physician assistants. Most will participate in MIPS, though there will be exceptions.


Read more about MACRA and Electronic Health Records:


What is an FQHC?

An FQHC is a federally qualified health center – an organization based in the community that provides both preventative care and primary care. This can go as far as dentistry and oral health, substance abuse services, and other health care regardless of the individual’s ability to pay.

An FQHC receives its funding from the Bureau of Primary Health Care along with the Centers for Medicare and Medicaid Services. Many underserved communities, including ones with above average poverty levels and large immigrant populations, rely on FQHCs.

How Does MACRA Affect FQHC Providers?

Some health centers will not notice a significant change under MIPS or MACRA. Their payment methods will not change if they continue to use a Medicare Part PPS that they have relied on in the past.

Another notable exception is that there is a volume threshold that will keep very small providers from being affected by MACRA. If the health center claims Medicare Part B reimbursements under $30,000 per year or treats under 100 Medicare patients, they will not have to engage in MIPS reporting. This will likely impact rural health centers more than urban ones.

MACRA and FQHC Providers

Keeping Ahead of MACRA and FQHC

Since MACRA determines healthcare reimbursements based on outcomes rather than volume, healthcare providers need to be ready to shake up their internal systems too.

At the minimum, there are three areas that will require considerable changes.

  1. Communication

The MACRA environment is ever-changing. It’s pivotal that FQHCs have open lines of communication with their state primary care association and the National Association of Community Health Centers. This will help streamline efforts towards MACRA implementation.

  1. Meaningful Use Compliance

Meaningful use attestation requirements are likely to change as some of them will roll into MACRA legislation. The Center for Medicare and Medicaid Services has a published list of program requirements that should help you make this transition easier.

  1. Data Integrity

MACRA necessitates in-depth reporting requirements. Your electronic medical records will be a key facet of this as they assist in complete and accurate data. If data is deemed to be compromised or inaccurate, you may not receive adequate compensation.

As a healthcare provider or administrator, maintaining effective records is now of paramount importance. If your reporting standards and practices are up to date, you won’t face any problems with payments or reimbursements. Plus, a clearer picture of your patient data shall help you react to any new legislative changes.

An FQHC Consultant Can Help

The qualifications under which an FQHC operates, as well as the reimbursement schedules under Medicare, can change quickly based on the whims of the federal government. Since you have a business to run and operations to look after, it can be difficult to keep abreast of all the changes.

The fact is that most medical providers are going to take a “wait and see” approach to how MACRA and MIPS will affect their organization moving forward. However, you can be sure that there will be higher rates of technology adoption and more stringent record keeping. Both can entail a structural change within your firm.

Hiring a top quality EMR consultant can be the difference between eventually adapting to a modest level, and adapting with rapid efficiency.


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