Medicare Access And CHIP Reauthorization Act (MACRA)

Achieve Better Outcomes, Lower Healthcare Costs, and Maximize Medicare Payments with QB’s Customized Solutions.

The enactment of MACRA replaced the Sustainable Growth Rate Model with a value-based payment system designed to provide physicians with a more sustainable approach to reimbursement. Through the Quality Payment Program, MACRA rewards physicians based on value rather than volume. However, while there are significant incentives for those who achieve strong scores, failure to identify and improve organizational weaknesses can lead to penalties if reporting is not done accurately. It’s important to note that MACRA applies exclusively to Medicare Part B (physician services) and the Children’s Health Insurance Program (CHIP).

Medicare Quality Payment Programs

Providers under the Quality Payment Program can choose between two tracks: (1) the Merit-based Incentive Payment System (MIPS) or (2) Advanced Alternative Payment Models (AAPMs). The choice of track depends on factors such as practice size, specialty, location, or patient population.

Merit-Based Incentive Payment System (MIPS)

Advanced Alternative Payment Models (AAPMs)

MACRA consolidates multiple quality programs into MIPS, which evaluates providers based on four performance categories: quality, cost, promoting interoperability, and improvement activities. These categories are used to calculate each provider’s composite performance score, which determines how their reimbursement is adjusted. Eligible physicians are compared to their peers across the U.S., and based on performance, they receive positive, neutral, or negative payment adjustments in future years.

AAPMs reward healthcare providers who deliver high-quality, cost-effective care. Providers who meet specific requirements through AAPMs may qualify for a 5% incentive payment, in addition to any model-specific payments they receive, and are exempt from MIPS reporting and payment adjustments.

QB’s MACRA Consulting Services

QB Consulting provides the expertise and resources to help you navigate MACRA successfully. We understand the complexities of the various reporting categories and the scoring process, and we can assess whether professionals in your organization are eligible and which systems they should be reporting under.

Our MACRA consulting services include:

  • Determining whether you qualify for MIPS or AAPMs
  • Identifying eligible clinicians for enrollment
  • Reviewing and assessing performance data from 2017 onward
  • Developing a strategic plan to meet industry standards and maximize Medicare payments
  • Tracking performance and providing regular progress reports
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With QB’s tailored solutions, you can navigate MACRA’s challenges, optimize your practice’s performance, and secure the maximum reimbursement possible.

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