MACRA: Weigh In on New Patient Relationship Categories

Beginning Jan. 1, 2018, you will have to report new patient relationship categories and codes on all Medicare claims. Before the codes can be developed, the Centers for Medicare & Medicaid Services (CMS) wants your input on a series of questions pertaining to the new categories. Review the draft categories, and weigh in by sending your comments to TMA at macra[at]texmed[dot]org by Aug. 1, 2016.

Provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) call for the new patient relationship categories and codes. MACRA will soon require physicians to choose between two major payment tracks: the Merit-Based Incentive Payment System (MIPS) and eligible alternative payment models (APMs) beginning in 2019. The intent of the new categories and codes is to describe your relationship to each patient to CMS for the purposes of attribution and cost measurement under the new payment tracks. 

CMS' five draft categories are:

  1. Clinician who is the primary health care provider responsible for providing or coordinating the ongoing care of the patient for chronic and acute care.
  2. Clinician who provides continuing specialized chronic care to the patient.
  3. Clinician who takes responsibility for providing or coordinating the overall health care of the patient during an acute episode.
  4. Clinician who is a consultant during the acute episode.
  5. Clinician who furnishes care to the patient only as ordered by another clinician.

TMA would like your input and will consider your opinions and feedback for inclusion in its comment letter. CMS will review all public comments and consider them in development of the operational list of patient relationship categories and codes. CMS will publish the final version in April 2017.

To submit comments directly to CMS, email patientrelationshipcodes[at]cms[dot]hhs[dot]gov by Aug. 15.

TMA is taking a two-pronged approach to the regulations coming from MACRA. TMA Vice President of Advocacy Darren Whitehurst and the TMA lobby team met with U.S. Rep. Michael Burgess, MD (R-Lewisville), medicine's good friend and the chief author of MACRA. Dr. Burgess shares TMA's concerns with how CMS is implementing MACRA. He is one of several congressional leaders who will be closely monitoring the agency's activities. At the same time, a TMA task force will develop tools and educational materials to help physicians understand and prepare for the new law. 

For more information, read "SGR Is Gone. Now What?" in the September 2015 issue of Texas Medicine.

Action, May 2, 2016

Last Updated On

May 02, 2016

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