Understanding MACRA: Everything you need to know about MIPS and positive payment adjustments

The landmark passage of the Medicare Access and CHIP Reauthorization Act (MACRA) marked one of the most significant changes to Medicare legislation that the healthcare industry has seen.

MACRA repealed the Medicare Part B Sustainable Growth Rate reimbursement formula and replaced it with a new method of distributing payments to providers called the Quality Payment Program (QPP).

There are two reporting tracks clinicians can adopt when participating in MACRA—the Merit-based Incentives Payment System (MIPS) and the Alternative Payment Model (APM). And within each of MIPS and APM there are two stepping-stone tracks, yielding a total of four MACRA participation tracks that are important for physicians and specific categories of clinicians (see list on page 5) to understand.

Of the four reporting tracks, the MIPS Eligible Clinician category (see Table 1) will apply to most practicing clinicians and providers and will become the “new default” category for providers treating Medicare Part B patients.

Very few clinicians are exempt and must report at least 90 consecutive days of MIPS performance data beginning this year. And because the ultimate outcome of this year’s performance measurements will determine payment adjustments in 2019, the focal point for clinicians for the duration of 2017 should be to fully understand the MIPS reporting requirements—who needs to report, what they need to report and how it will ultimately affect their bottom line.

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