The Quality Payment Program/MACRA
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), also called the Quality Payment Program, is a bipartisan legislation signed into law on April 16, 2015, with a promise to fundamentally change the way of evaluating and paying for health care.
MACRA repeals the Sustainable Growth Rate (SGR) formula, changes the way that Medicare rewards clinicians for value over volume, streamlines multiple quality programs under the new Merit-Based Incentive Payments System (MIPS), and provides bonus payments for participation in eligible alternative payment models (APMs).
The most significant use of QPP/MACRA is setting up new ways to pay physicians for caring Medicare beneficiaries. New funding for technical assistance to providers and funding for measure development and testing are also included which enable new programs and requirements for data sharing and create new federal advisory groups. This comprehensive legislation has the potential to significantly restructure health care.
The QPP/MACRA’s Two Reimbursement Structures
Alternative Payment Models (APMs)
Most providers who take part in APMs will receive favorable scoring, with correspondingly higher reimbursement rates.
Merit-Based Incentive Payment System (MIPS)
Providers will receive adjustments to their Medicare Part B Payment base rate that will increase each year from 2019 through 2022.
- Next Generation ACO Model
- Comprehensive ESRD Care (CEC) Model – Two-Sided Risk
- Comprehensive Primary Care Plus (CPC+) Model
- CPC+ only: Eligible clinicians were assessed only as part of their CPC+ Practice group.
- CPC+ and Medicare Shared Savings Program (Shared Savings Program) Tracks 2 or 3: Eligible clinicians were assessed only as part of their Shared Savings Program Track 2 or 3 ACO.
- Medicare Shared Savings Program (Track 2 & 3)
- Quality (Replaces PQRS)
- Improvement Activities (New Category)
- Advancing Care Information (Replaces the Medicare EHR Incentive Program also known as Meaningful Use)
- Cost (Replaces the Value-Based Modifier)
Quality Payment Program Participants
To be eligible for the program, you must meet both the minimum billing of $30,000 in Part B allowed charges a year and the number of Medicare patients which is 100 per year. Also, a participant must be a:
- Physician assistant
- Nurse practitioner
- Clinical nurse specialist
- Certified registered nurse anesthetist
You are not required to participate in the Quality Payment Program if 2017 is your first year to participate in Medicare.
To Learn How We Can Help You in Participating with the Quality Payment Program (QPP), You Can Reach Us Today Through the Form Below: