MACRA – What is it?

MACRA is Medicare Access and CHIP Reauthorization Act designed by CMS to reward Healthcare providers for giving better care instead of more service. MACRA aims to streamline reimbursement reporting which will depending on the quality of care provided and a host of other measures, eventually result in bonuses for clinicians and doctors who perform well. However, it will also bring negative incentives for those whose performance is below par.

Reporting under the Quality Payment Program (QPP) of the Medicare Access and CHIP Reauthorization Act begins in 2017 (MACRA).

The Quality Payment Program has two tracks you can choose:


If you decide to participate in an Advanced APM, through Medicare Part B you may earn an incentive payment for participating in an innovative payment model.

If you decide to participate in MIPS, you will earn a performance-based payment adjustment.

To be successful under either, groups are required not only to track measures and activities but to perform well in those areas—and even to outperform their peers.

How will the QPP impact my Medicare Payments?

Medicare Access and CHIP Reauthorization Act (MACRA) significantly changes how Medicare will reimburse physicians in the future.

With greater emphasis on quality, value and physicians taking more financial risks, MACRA makes three important changes to how Medicare pays those who give care to Medicare beneficiaries.

These changes create a Quality Payment Program (QPP) and aims at making a new framework for rewarding health care providers for giving better care not more just more care.

MACRA does away with the Sustainable Growth Rate (SGR) formula, and adopts two new QPP paths – The Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs).

The MACRA abolishes the SGR and from 2015 through 2025 provides physicians with a stable, sometimes flat, update to the Medicare physician fee schedule payment rates. Beginning 2026, physicians and other health care professionals will receive different annual updates depending on whether they are paid under the new MIPS (0.25%) or primarily through advanced APMs (0.75%).

What if I do not participate in the QPP?

Without the passage of MACRA, physicians could have been subject to negative payment adjustments of 11% or more in 2019 as a result of the MU, PQRS and VBM programs, with even greater penalties in future years. In contrast, under MACRA, the largest penalty a physician can experience in 2019 is 4%, and most physicians will be able to avoid any negative adjustments in the 1st year. MACRA also provides incentives for physicians to develop and participate in different models of health care delivery and payment known as alternative payment models (APMs).

So If you don’t send in any 2017 data, then you will be subject to a negative 4% payment adjustment.

Who is in the Quality Program?

You’re a part of the Quality Payment Program in 2017 if you are in an Advanced APM or if you bill Medicare more than $30,000 a year and provide care for more than 100 Medicare patients a year. You must both meet the minimum billing and the number of patients to be in the program. If you are below either, you are not in the program.

For MIPS, you must also be a:

  • Advanced Alternative Payment Models (APMs) or
  • The Merit-based Incentive Payment System (MIPS)
  • Physician
  • Physician assistant
  • Nurse practitioner
  • Clinical nurse specialist
  • Certified registered nurse anesthetist

If 2017 is your first year participating in Medicare, then you’re not in the MIPS track of the Quality Payment Program.

Contact Information


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CA 92808, USA

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