MACRA (Medicare Access and CHIP Reauthorization Act)

MACRA was enacted to replace the Sustainable Growth Rate formula so that growth in per beneficiary Medicare expenditure does not exceed GDP growth. The act changes the way Medicare pays for clinicians – they are rewarded for value rather than volume. MACRA applies for Medicare Part B only (physician services) and CHIP.

MACRA created two Quality Payment Programs

  • Merit Based Incentive Program (MIPS)
  • Advanced Alternative Payment Models (AAPMs)

3Gen Consulting is equipped with the expertise and tools you need to succeed with MACRA, MIPS and AAPMs. We understand the multiple categories of reporting for MACRA and how the scoring is done. We can determine if professionals in your organizations are eligible and which systems they should be reporting under. We help you identify your organizational strengths and weaknesses and provide a plan on maximizing your Medicare payments.

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.

Advanced Alternative Payment Models (AAPMs)

AAPMs financially rewards healthcare providers who deliver high-quality, cost-effective medical care. If a clinician achieves threshold levels of payments or patients through AAPMs, they are offered a 5% incentive payment and are excluded from the MIPS reporting requirements and payment adjustments.

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