Navigating the MACRA Basics

What is MACRA?

MACRA is the Medicare Access and CHIP Reauthorization Act of 2015. The MACRA legislation repealed the previous payment plan and replaced it with a new program with an increased focused on quality and efficiency.

Who is affected by MACRA?

Providers with 200 or more Medicare Part B beneficiaries, or with Medicare Part B charges annually of $90,000.

What is the Quality Payment Program?

The Quality Payment Program is the umbrella term used to describe the MIPS and AAPM tracks under MACRA.

MACRA established two tracks for the Quality Payment Program:

  • Merit-based Incentive Payment System (MIPS), and
  • Advanced Alternative Payment Models (AAPMs);

What is Merit-Based Incentive Payment System (MIPS)?

The Merit-based Incentive Payment System (MIPS) is one of two tracks under the Quality Payment Program, that includes four category weightings that contribute to a yearly performance score. The final score determines MIPS payment adjustments.

The following is the performance category weighting for 2018:

  • Quality 50%
  • Cost 10%
  • Improvement Activities 15%
  • Advancing Care Information 25%.

What is an Advanced Alternative Payment Model (APM)?

For a provider to be eligible to participate in an Advanced Alternative Payment Model (APMS) they must use Certified EHR Technology, report quality measures and be either: (1) a Medical Home Model or (2) require participating APM Entities to bear more than a nominal amount of financial risk for monetary losses. Providers who are eligible could qualify for:

  • Yearly 5% bonus payments from 2019 through 2024;
  • In 2026, higher annual premiums (for some participating providers); and
  • Increased flexibility through physician-focused payment models

What if a provider chooses not to participate in MACRA?

If a provider chooses not to submit their information, they are subject to a 4% payment adjustment in 2019. The penalty increases annually to 5% in 2020, 7% in 2021 and 9% in 2022.

What if I opt out of Medicare?

Physicians who do not accept payments from Medicare will not be affected by payment adjustments in MIPS.

For more information regarding the Quality Payment Program visit: