MACRA Exemptions

There's been a lot of focus on what MACRA is. I'll leave that to the millions of other articles out there describing it. I'm going to focus on a less covered, but equally important topic: exemptions. 

You are exempt if you see less than 100 Medicare patients OR collect less than $30,000 in Medicare payments in a calendar year. The key word is OR - a provider only has to be below one threshold to qualify for an exemption. This will impact sole practitioners the most, and fields such as mental and behavior health. 

This gets tricky if you bill under a group NPI and the group does not qualify for an exemption. In this case, the group would have to adhere to MACRA standards starting in '17, as would the rendering providers. Individual providers under either threshold, however, are exempt for 2017. 

I like the exemption being one-year vs multi-year and applaud CMS for adopting the rule this way. The MACRA standards will continue to drag healthcare more into technology, which is badly needed.  

If you'd like to learn more, please email me at