What is MACRA?

On April 16, 2015 President Obama signed into law the Medicare Access and CHIP Reauthorization Act (MACRA), which replaces the current Medicare reimbursement schedule with a new pay-for-performance program that’s focused on quality, value, and accountability. MACRA provides physicians strong incentives to participate in Medicare risk-sharing Alternative Payment Models (APMs). Physicians who are not involved in APMs will be required to report and perform well on four categories – quality, advancing care information, improvement activities and cost.

MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, or “MIPS”.

What is MIPS?

The Merit-Based Incentive Payment System (MIPS) is the new program that will determine Medicare payments and adjustments. Using a composite performance score (‘MIPS score’ – between 0 and 100), eligible professionals (EPs) may receive a payment bonus (potential increased reimbursement by 27% by 2019), no Medicare Part B payment adjustment, or a negative Medicare Part B payment adjustment (possible decreased reimbursement by 9% by 2019).

The Composite Performance Score is based on:

  1. Quality – replaces PQRS (50%)
  2. Cost – replaces the Value Based Modifier (10%)
  3. Clinical practice improvement activities (15%)
  4. Advancing Care Information (25%)

What is APM?

The Alternative Payment Model (APM) is a shared risk model that allows practices to earn higher by tying more payment to patient outcomes. An immediate benefit from participating in Advanced APMs is a 5% Medicare incentive payment from 2019-2024.

Do I have to participate?

While there is no opt out of MACRA, in 2018 you are not subject to MIPS if:

  1. Your Medicare Part B allowed charges are less than or equal to $90,000 OR
  2. You see less than or equal to 200 Medicare Patients OR

To check your eligibility to MIPS, please contact us at (800) 811-2103 x11

The MedConverge Advantage:

MedConverge has the knowledge, expertise and technology that will help you with your MACRA/MIPS Reporting

  • Data aggregation expertise
  • Quick turn around time with recommendations
  • Real time monitoring of performance
  • Collaboration with management to develop a process improvement plan
  • Educational Resources

Are you ready for MACRA? Contact us and we can help you avoid financial penalties and prosper in this new environment!