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OIG Report Says CMS Still Has Work to Do on MACRA

Although you are expected to begin gathering data for the Medicare Access and CHIP Reauthorization Act (MACRA) in 2017, a recent report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) indicated that there’s still more work to be done to ensure everyone has the tools and guidance necessary to comply with the program.

Because of the “importance and complexity of these reforms and the tight timeline,” the OIG conducted an early implementation review of the Center for Medicare and Medicaid Services’ (CMS) MACRA efforts. To conduct this review and compile the resulting report, OIG interviewed CMS staff and reviewed internal agency documents and publicly available information.

As a result of this review, the OIG said CMS needs to do two main things in 2017 to address potential vulnerabilities in the program:

  1. Provide sufficient guidance and technical assistance to ensure clinicians are ready to participate in the Quality Payment Program (QPP). This includes technical assistance, training efforts and additional guidance that the agency promised in the Final Rule to help clinicians with the following:
    • Understand the QPP
    • Take advantage of the transition year to familiarize themselves with the program
    • Select the QPP participation option that best suits their practice
    • Use QPP performance feedback to improve their care delivery to Medicare beneficiaries.


  1. Develop IT systems to support data reporting, scoring and payment adjustment. These systems are necessary to allow the following:
    • Clinicians can report QPP data to CMS accurately and with minimized burden
    • CMS can validate the data it receives and calculate the MIPS Final Score
    • The agency can provide useful performance feedback to clinicians
    • CMS can accurately adjust Part B payment based on clinicians’ QPP participation.

In response to the report, CMS stated that it is committed to providing patient-centered, high-quality care for Medicare beneficiaries. But it recognized the challenges to be faced complying with MACRA especially by small and rural medical practices.

As for the two identified vulnerabilities, CMS indicated that as it implements the QPP, it is “committed to continuing to engage with clinicians and provide them with assistance, and to optimize backend IT systems support.” Further, the agency noted that it has instituted “ongoing efforts to spur the creation of innovative, customizable tools to reduce burden on clinicians, while also supporting high-quality care for patients.”

As a result of these efforts, CMS indicates that you should look for further developments, including new online tools, that will ease your compliance with MACRA.

You can obtain a copy of OIG’s report at

Coding Leader offers multiple resources to help with your MACRA compliance, and you can find them at

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