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Find answers to frequently asked questions about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
This law repeals the Medicare sustainable growth rate (SGR) formula that was used to determine Medicare payments for health care providers’ services. MACRA establishes an alternative set of predictable annual baseline payment updates and two payment pathways: the Merit-Based Incentive Payment System (MIPS) path and the Alternative Payment Model (APM) path.
The following is a timeline for MACRA implementation:
Details on both MIPS and APMs will be the subject of policymaking for several years and the ACR will keep the membership informed.
The ACR is committed to providing its members with resources and support to steer through the complication of MACRA.
The Merit-Based Incentive Payment System is a new program in the Medicare fee-for-service payment system. It consolidates three existing programs—meaningful use (MU), the Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBPM)—into a single program.
The MIPS will assess individual physician performance in four categories to generate a composite score on a 0- to 100-point scale. The categories are:
Beginning in 2019, physicians participating in the MIPS will be eligible for positive, negative or neutral Medicare payment adjustments that start at 4 percent and gradually increase to 9 percent for 2022. The threshold for these payment adjustments will be the mean composite score for all MIPS-eligible professionals during the previous performance period.
Participation in an APM can help with composite score for a MIPS professional
Physicians whose composite score is at the threshold (i.e., earn the mean composite score) will not receive a MIPS payment adjustment.
Physicians whose composite scores are above the threshold will receive positive payment adjustments on each claim for the following year.
Physicians whose composite scores are below the threshold will receive negative payment adjustments on each claim for the following year.
Physicians with high composite scores will be eligible for a positive payment adjustment that is up to three times the baseline positive payment adjustment for a given year. For example, the baseline positive payment adjustment for 2019 will be 4 percent, so high performers will be eligible for a positive payment adjustment of up to 12 percent.
Beginning in 2026, all physicians participating in the MIPS will be eligible for a 0.25 percent increase in their payments each year.
MACRA defines any of the following as an alternative payment model:
Yes. An APM must require participants to meet all of the following criteria:
Eligible physicians who choose to participate in a qualifying APM will receive a 5 percent lump-sum bonus on their Medicare payments for 2019 through 2024. Beginning in 2026, all physicians participating in qualified APMs will be eligible for a 0.75 percent increase in their payments each year.
Registry use counts in all domains of MIPS, including practice improvement, quality improvement, and EHR use. RISE contains a number of important features, including:
Participation in a registry like RISE, a Qualified Clinical Data Registry (QCDR), will positively impact scores in clinical practice improvement activities under MIPS.
Contact RISE@rheumatology.org to learn how to sign up for free.
HR 2 (the MACRA bill)
MIPS & APMs