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MACRA Quality Payment Program Resource Center

Learn how value-based reimbursement will impact your practice and how to prepare for MIPS and Advanced APMs.

 

 

About MACRA                How It Works            Additional Resources

On-Demand Webinar: Preparing Your Practice for MIPS

View our on-demand webinar recording discussing the MACRA Final Rule. In this webinar you'll learn how to begin reporting data under the Merit-based Incentive Payment System (MIPS) during the 2017 transition year and how each category will be used to calculate your final MIPS score.

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MACRA Quality Payment Programs Webinar

What is the MACRA Quality Payment Program?

The Quality Payment Program improves Medicare by helping you focus on care quality and the one thing that matters most — making patients healthier. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, which threatened clinicians participating in Medicare with potential payment cliffs for 13 years. If you participate in Medicare Part B, you are part of the dedicated team of clinicians who serve more than 55 million of the country’s most vulnerable Americans, and the Quality Payment Program’s purpose is to provide new tools and resources to help you give your patients the best possible care. You can choose how you want to participate based on your practice size, specialty, location, or patient population.

The Quality Payment Program has two tracks you can choose:

  • Advanced Alternative Payment Models (APMs) or
  • The Merit-based Incentive Payment System (MIPS)

If you decide to participate in an Advanced APM, through Medicare Part B you may earn an incentive payment for participating in an innovative payment model.

If you decide to participate in traditional Medicare Part B, then you will participate in MIPS where you earn a performance-based payment adjustment.

What is MACRA?

How It Works

Merit Based Incentive Payment System Timeline

Performance Period

The first performance period is from January 1, 2017 to December 31, 2017. Eligible Providers have until October 2, 2017 to record quality data and how technology was used in their practice to improve performance. If an Advanced APM fits your practice, then you can provide care during the year through that model.

Send in Data

Data about the care you provided and how you used technology in your practice in 2017 must be submitted by March 31, 2018 for MIPS (to earn a positive payment adjustment). To earn the 5% incentive payment for participating in an Advanced APM, send quality data through your Advanced APM.

Feedback

Medicare provides feedback to your practice about your performance after you have sent in your data.

Payment

Positive MIPS payment adjustments begin January 1, 2019 if you submit your 2017 data by March 31, 2018. If you participate in an Advanced APM in 2017, then you may earn a 5% incentive payment in 2019.

 

How will the MACRA Quality Payment Program change reimbursement? 

Depending on the data you submit by March 31, 2018, your 2019 Medicare payments will be adjusted up, down, or not at all. The information provided below is only relevant for the 2019 payment year. CMS will provide additional information on payment adjustments for 2020 and beyond beginning next year.

Submitting Data for MIPS

Submit Minimum Data

Submit a minimum amount of 2017 data to Medicare and you can avoid a downward payment adjustment. This minimum amount could be, for example, one quality measure or one improvement activity for any point in 2017.
Submitting a Partial Year of MIPS

Submit a Partial Year

Submit 90 days of 2017 data to Medicare and you may earn a neutral or small positive payment adjustment.

 

Submit a Full Year of MIPS

Submit a Full Year

By submitting a full year of 2017 data to Medicare, you may earn a moderate positive payment adjustment. 

Don't Participate

Don't Participate

By not participating in the Quality Payment Program you won't send in any data in 2017 and you will receive a negative 4% payment adjustment in 2019.

When Does the Quality Payment Program Start?

You get to pick your pace for the Quality Payment Program. If you're ready, you can begin January 1, 2017 and start collecting your performance data. If you're not ready on January 1, you can choose to start anytime between January 1 and October 2, 2017. Whenever you choose to start, you'll need to send in your performance data by March 31, 2018.

The first payment adjustments based on performance go into effect on January 1, 2019.

 

Who is Eligible for Participation in the Quality Payment Program?

You’re a part of the Quality Payment Program if you bill Medicare more than $30,000 a year and provide care for more than 100 Medicare patients a year, and are a:

  • Physician
  • Physician assistant
  • Nurse practitioner
  • Clinical nurse specialist
  • Certified registered nurse anesthetist

If 2017 is your first year participating in Medicare, then you’re not in the MIPS track of the Quality Payment Program.

Additional Resources to Assist You with MACRA
CMS QPP Website
Visit the QPP Website

Check out the resources developed by CMS on the Quality Payment Program (QPP).

Go to CMS Site

The Merit Based Incentive Payment System
Learn About MIPS

Prepare  for participation in the Merit Based Incentive Payment System (MIPS).

Learn About MIPS

AMA Steps Forward Website
Visit the AMA Steps Forward

Discover the Steps Forward Practice Transformation Series learning module for clinicians by the AMA.

Go to AMA Site

The Latest on MACRA from Our Blog

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