Health Informatics and MACRA Compliance: Electronic Health Records in Medicare Reimbursement Policy
Overview
This fact sheet examines the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its role in healthcare reimbursement policy. It analyzes how health informatics, particularly electronic health record (EHR) adoption through the Promoting Interoperability Programs, has become essential for healthcare organizations to achieve compliance and secure full reimbursements under the Merit-based Incentive Payment System (MIPS).
What this coursework covers
- Overview of MACRA and the shift from Sustainable Growth Rate Formula to Quality Payment Program
- Role of health informatics and EHR implementation in MACRA compliance
- Centers for Medicare & Medicaid Services initiatives and Promoting Interoperability Programs requirements
Preview
Assignment Policy/Regulation Fact Sheet
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Assignment Policy/Regulation Fact Sheet
Because few patients pay out-of-pocket for services, those working in the healthcare system report reimbursement from insurers as their biggest concern. Most healthcare organizations depend on payouts from both public and private insurers for their revenue, especially the federal health insurance program Medicare. The Department of Health & Human Sciences (HHS) instituted the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in October 2016 as part of the new payment plan for healthcare organizations treating Medicare patients (Healthit.gov, 2019a). MACRA is an incentive program where providers and staff members are rewarded based on the quality of care they give to patients: it ended the Sustainable Growth Rate Formula by establishing the Quality Payment program (QPP). Health informatics is a critical aspect of ensuring healthcare organizations are not only compliant to MACRA, but that full reimbursements are made.
Given the benefits of collecting and analyzing patient and provider data, the federal government has been pushing for widespread implementation of electronic health records countrywide. The Centers for Medicare & Medicaid Services (CMS) is encouraging eligible providers, especially critical access hospitals, and staff to adopt and positively implement certified electronic health record (EHR) technology through the Promoting Interoperability Programs (Dagliati et al., 2021). The Promoting Interoperability Programs involves instituting necessities for the electronic gathering of clinical data, including giving patients electronic copies of their health information (Healthit.gov, 2019b).