The Medicare Access and CHIP Reauthorization Act (MACRA) is legislation that replaced the Sustainable Growth Rate (SGR). It outlines a new program that started on January 1, 2017 for physician reimbursement that replaces fee-for-service with value-based payments under the Quality Payment Program (QPP).
What is the Quality Payment Program?
The QPP is the portion of MACRA that defines the new value-based reimbursement system. It has two parts: the Merit-Based Incentive Program (MIPS) and Advanced Alternative Payment Models (APMs). The QPP replaces and consolidates the current Meaningful Use, PQRS, and value-based modifier programs.
The majority of eligible clinicians (ECs) will participate in MIPS in 2017. The following ECs must participate in the QPP in 2017 or they will receive a -4% payment adjustment in 2019 on all Medicare Part B claims.
- Physician (Doctors of Medicine or Osteopathy, Doctors of Dental Surgery or Dental Medicine, Doctors of Podiatric Medicine, Doctors of Optometry, Chiropractors)
- Physician Assistant
- Nurse Practitioner
- Clinical Nurse Specialist
- Certified Registered Nurse Anesthetist
There are some exclusions, and there are some providers will participate in Advanced APMs. To find out if you should be participating in MIPS or ADvanced APMs or are excluded you can take this short, simple assessment.
For more MACRA resources, visit the Kareo MACRA Resource Center.