Everything There Is to Know About MACRA and FQHC

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Are you a clinician or a member of a Federally Qualified Health Center (FQHC) struggling to navigate the intricacies of Medicare Access and CHIP Reauthorization Act (MACRA)? In this blog, you’ll learn everything you need to know about MACRA and FQHCs, and how they work together in the healthcare industry.

We’ll break down the intricacies of these complex topics, providing clear explanations and practical tips to help you optimize your reimbursement opportunities.


Understanding MACRA: Revolutionizing Healthcare Payment Structures for Medicare Patients

MACRA was introduced in 2015 to reform the payment structure for healthcare providers who treat Medicare patients. The purpose of MACRA is to shift the focus of healthcare providers towards value-based care from traditional fee-for-service models.

Under MACRA, there are two payment tracks: the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). MIPS is a performance-based payment system that adjusts payments based on how well healthcare providers perform in four categories: quality, cost, improvement activities, and advancing care information.

The MIPS reporting period is 12 months, and eligible clinicians must meet a volume threshold of patients or payments to participate in MIPS. Healthcare providers receive a composite score based on their performance in these areas, which determines the bonus or penalty they receive on top of their Medicare fee schedule.

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Alternatively, APMs are payment models that incentivize healthcare providers to provide efficient, high-quality care by tying payments to outcomes rather than volume. APMs include models such as accountable care organizations (ACOs) and bundled payment arrangements. Eligible clinicians who participate in APMs can receive incentive payments for providing high-quality care.

FQHCs, rural health clinics, and community health centers have an exemption from MIPS reporting requirements and can participate in the quality payment program through APMs.

This is an opportunity for primary care providers to enhance care delivery, improve patient outcomes, and receive a payment adjustment under the payment system.


Understanding FQHC and MACRA: What Services Are Covered and Who Is Eligible?

Federally Qualified Health Centers (FQHCs) are comprehensive, community-based primary care facilities that provide essential health services to underserved communities in the United States. FQHCs are funded by the Health Resources and Services Administration (HRSA) and are designed to offer affordable healthcare services to low-income individuals and families.

As a result, they are instrumental in ensuring everyone has access to essential healthcare services regardless of their socio-economic status.


To be eligible for FQHC services, a person must meet certain requirements, such as being uninsured, underinsured, or have Medicaid or Medicare. 

They must also reside in an underserved area or be part of an underserved population group, which means that they live in an area with a shortage of primary care or dental services, or they belong to a demographic that experiences barriers to healthcare access, such as poverty, language, or cultural barriers.

FQHCs are required to report certain information to the HRSA on an annual basis. This information includes data on patient demographics, health conditions, outcomes, the types of services provided, and financial information.

FQHCs must also meet certain quality standards and performance indicators to maintain their status as FQHCs. These reports ensure that FQHCs are transparent in their operations and are meeting the healthcare needs of their patients effectively.

For community health centers, including FQHCs, MACRA presents a unique opportunity to improve their revenue streams and provide better care for their patients.

Here’s a breakdown of activities for MACRA.
Source: LUGPA


Navigating the Intersection of FQHCs and MACRA

MACRA led to the establishment of the QPP. This program has had a significant impact on FQHCs, as it has changed how they are paid for services. Under MACRA, FQHCs are exempt from MIPS reporting, which is used to measure and reward quality care.

This means that FQHCs will not be subject to penalties or receive bonuses based on their performance under MIPS. However, FQHCs can still participate in Advanced APMs and qualify as Qualifying APM Participants (QP).

In addition, MACRA does not affect FQHC PPS payments. The Medicare payment system for FQHCs remains unchanged, meaning they will continue to receive their regular payments from Medicare.

This is beneficial for both patients and providers, as it allows FQHCs to focus on providing quality care without worrying about financial incentives or penalties.

To maximize their performance under MACRA, FQHCs should participate in the QPP, prioritize meeting the performance measures outlined in MIPS and APM, and ensure they have the necessary resources to track and report on these measures.

By doing so, FQHCs can use MACRA as a benchmark to assess their performance and take corrective actions where necessary to improve the quality of their services.




3 Ways FQHCs Can Stay on Top of MACRA Compliance


To ensure that FQHCs maintain their status and continue to provide high-quality care, they must stay on top of MACRA compliance.

Here are three ways FQHCs can do just that:


1.  Adopt Data Analytics

Understanding how MACRA works and identifying areas for improvement is crucial for FQHCs to optimize reimbursement opportunities. By analyzing data from patient visits, claims history, and other sources, FQHCs can develop targeted strategies to improve compliance.


2. Develop Strategies That Meet Program Requirements

FQHCs need to develop quality measures that demonstrate improved outcomes for patients and cost-saving initiatives such as reducing readmissions or improving medication adherence rates. Investing in technology solutions that automate MACRA compliance processes is also important.


3. Leverage Technology to Streamline Operations

Electronic health records (EHRs) can help improve accuracy in reporting quality measures while providing access to real-time data about patient care delivery. Automated reminders and notifications can also ensure staff members meet deadlines for submitting reports or completing tasks related to MACRA compliance.

By adopting these strategies and leveraging technology, FQHCs can stay on top of MACRA while improving the quality of care for their patients.


Meet MACRA Requirements with Ease: ISOwire’s Comprehensive Healthcare IT Solutions for FQHCs

FQHCs face unique challenges in meeting the regulatory requirements of the rapidly evolving healthcare industry. To help FQHCs stay ahead of the curve, ISOwire offers comprehensive healthcare IT Services that are designed to help you meet MACRA requirements.

ISOwire’s MACRA-compliant solutions include an automated reporting system that simplifies the filing of quality measures, a secure cloud-based platform for patient data management, and real-time analytics to track performance improvements.

These solutions enable FQHCs to quickly and accurately report on their performance without having to invest in costly software or hire additional staff. By leveraging top-of-the-line technology solutions, ISOwire can help FQHC to streamline their operations and reduce the burden of compliance.

If you’re looking for a partner to help your FQHC succeed under MACRA, contact ISOwire today.