The Medicare Access CHIP Reauthorization Act (MACRA) changes the way Medicare pays providers. MACRA repeals the Sustainable Growth Rate formula, streamlining multiple quality reporting programs into the newly formed Quality Payment Program (QPP), and rewarding value over volume.
Eligible clinicians under MACRA can participate in one of two payment paths:
- Merit Based Incentive Payment System (MIPS); or
- Advanced Alternative Payment Models (A-APMs)
Most Medicare Part B clinicians will be subject to MIPS. Under MIPS, providers will receive adjustments to their Medicare fee-for-service reimbursement based on a composite performance score measuring i) quality, ii) resource use (cost), iii) clinical practice improvement activities, and iv) advancing care information.
CMS incentivizes providers to participate in Advanced APMs, the alternative to payment under MIPS. Providers who participate in Advanced APMs can avoid MIPS and receive an annual 5 percent bonus on top of their Medicare Part B reimbursement. CMS applies thresholds to Advanced APMs to determine if the model is a qualifying participant. If the Advanced APM meets the thresholds, then the participants are excluded from MIPS and eligible for the annual 5 percent bonus.
Advanced APMs under MACRA include: MSSP ACO Tracks 1+, 2 and 3; Next Generation ACO Model; Comprehensive ESRD Care Model; Oncology Care Model; and Comprehensive Primary Care Plus Model.
Read more about MACRA.