On April 16, 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law. The legislation’s purpose was two-fold. It repealed the sustainable growth rate (SGR) and introduced a new quality reporting program called the Merit-Based Incentive Payments System (MIPS).

As we enter into 2016, MIPS will take on more importance as some of the requirements of the program start to take shape. Here are the five key things you need to know about MIPS.

In an effort to ensure that consumers are able to rightfully access their health information, the Health and Human Services Department released new guidance on the HIPAA Privacy Rule. The guidance covers information such as patients' general rights to their protected health information, what data is excluded from that right to access, how an individual may request access and how an entity must provide the information, among other topics.

Meaningful Use Stage 3

Health systems across the U.S. are urging the Department of Health and Human Services (HHS) to delay implementing Meaningful Use Stage 3. In a letter sent to HHS Secretary Sylvia Burwell, these organizations expressed concerns that the release of Stage 3 will hinder much needed efforts to improve technology to achieve interoperability.

The New York State Internet System for Tracking Over-Prescribing (I-STOP) Act establishes a real-time database which tracks controlled substance prescriptions issued by every doctor in the state of New York. The database allows doctors and pharmacists to have access to, and keep track of, all of the controlled substance prescriptions their patients are receiving. It is the first piece of statewide legislation enacted to help combat the rising rates of prescription drug abuse.

Speaking at the J.P. Morgan Annual Health Care Conference on Jan. 11, Acting Administrator Andy Slavitt announced that CMS is in the process of phasing out the Meaningful Use program to make way for a new, more modernized program. “The Meaningful Use program as it has existed, will now be effectively over and replaced with something better.”

The passage of the Patient Access and Medicare Protection Act was a significant win for healthcare providers stressed about being able to attest to meaningful use. The legislation, signed into law by President Obama in late December, allows eligible hospitals and eligible physicians to apply for a hardship exceptions under the 'unforeseen circumstances' category.

Higher out-of-pocket costs, new reimbursements models, and rising operating costs are just a few of the trends that will impact provider revenue cycles in 2016. These industry developments will force providers to evaluate existing RCM strategies and possibly implement new technologies and workflows to simultaneously maintain financial health and address evolving consumer and regulatory demands.

2016: PQRS 2016 By the Numbers

CMS has released the Physician Quality Reporting System (PQRS) specifications for the 2016 reporting period and as previous years indicate, they are full of changes. Since inception, PQRS has greatly changed the coding and documentation landscape for Eligible Professionals (EP) and Group Practices. Reporting on quality measures has become a way of life for the practicing physician. Whether the reporting is being executed through a registry, allowed for most all standard measures and measure groups, or by individual physicians utilizing claims-based reporting, the additional time and monetary importance is not inconsequential. Physicians are being asked to do more and more each year so it’s vitally important for them to have an intuitive and robust system for collecting the data.

A focus on Patient Engagement will continue to lead the way for healthcare IT initiatives in 2016. Patients have, for decades, been stuck in the middle as doctors continued to communicate through antiquated methods…fax machines, paper scripts, little to no online presence, and the list goes on.

With increasing patient out-of-pocket requirements, eMDs expects to see the demand for technologies which can help practices estimate patient responsibility at or before time of service. Eligibility is moving upstream to start getting a more accurate payment estimation based upon plans. That can be a function of both eligibility and/or contracting depending upon the technology “solution” approach. There are quote marks around the solution because the reality is that no matter how much data moves back and forth, there are still industry realities which act as constraints.