Medicare Access And CHIP Reauthorization Act (MACRA)

MACRA was enacted to replace the Sustainable Growth Rate Model with a value-based system, in order to provide physicians with a more sustainable payment system. Physicians are now rewarded for value rather than volume with the Quality Payment Program created by MACRA. While there is a significant upside for those who have stronger scores, payments from CMS can also result in penalties, if organizational weaknesses are not identified and improved and in turn reporting is not done accurately. It is important to note that MACRA applies only for Medicare Part B (physician services) and Children’s Health Insurance Program (CHIP).

Medicare’s Quality Payment Programs

Providers can choose from two tracks under the Quality Payment Program – (1) Merit-based Incentive Program (MIPS) or (2) Advanced Alternative Payment Models (AAPMs) – based on their practice size, specialty, location, or patient population.

Merit Based Incentive Program (MIPS)

MACRA streamlines multiple quality programs under MIPS. MIPS establishes four performance categories – quality, cost, promoting interoperability and improvement activities – which are used to calculate each provider’s composite performance score based on which reimbursement amounts are adjusted. Eligible physicians are evaluated on their performance relative to other physicians in the United States and receive a positive, neutral, or negative adjustment to their payments in a future payment year.

Advanced Alternative Payment Models (AAPMs)

AAPMs financially rewards healthcare providers who deliver high-quality, cost-effective medical care. If clinicians achieve certain requirements through AAPMs, they are offered a 5% incentive payment in addition to any model-specific payments they receive, and are excluded from the MIPS reporting requirements and payment adjustments.


Our MACRA Consulting Services

We are equipped with the expertise and tools you need to succeed with MACRA. We understand the multiple categories of reporting for MACRA and how the scoring is done. We can determine if professionals in your organization are eligible and which systems they should be reporting under.

  • Determine the MACRA track you qualify for – MIPS or AAPMs
  • Identify eligible clinicians for enrollment
  • Review and assess performance for 2017 to date
  • Develop a plan to achieve industry standards and maximize Medicare payments
  • Track your performance and provide reports regularly
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