You are using an outdated browser. Please upgrade your browser to improve your experience.

You are using an outdated browser.

To ensure optimal security, this website will soon be unavailable on this browser. Please upgrade your browser to allow continued use of ACP websites.

You are here

HomePractice ResourcesBusiness ResourcesPaymentMedicareMACRA and the Quality Payment Program

MACRA and the Quality Payment Program

     

    MACRA and the Quality Payment Program

    Transitioning from a volume-based payment system to one that rewards value.

     

    The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 16, 2015. The law provides a more predictable Medicare payment schedule for physicians and other clinicians with intentions of moving from a volume-based system to a system that rewards value. This new payment system is called the Quality Payment Program (QPP).

    Read how ACP advocated on behalf of clinicians and influenced the MACRA Rules:

    MORE ACP ADVOCACY ON MACRA

    MACRA Physician

    Submit Your 2018 MIPS Data

    CMS has transitioned to the new HCQIS Authorization Roles and Profile (HARP) system. Previously, clinicians received their credentials through the Enterprise Identity Management (EIDM) system.

    • Previous EIDM Accounts: For all clinicians who previously had an EIDM account, you were automatically transitioned to HARP, and will use your existing EIDM user ID and password to sign in to the QPP website.
    • New Clinicians: For all clinicians who didn’t have an EIDM account, you’ll need to enroll with HARP. For a step-by-step guide to signing up for a HARP account, refer to the QPP Access User Guide.
    Important Deadlines:
    • Claims - CMS will receive quality data from Part B claims processed by your Medicare Administrative Contractor. All claims must be processed within 60 days of 12/31/2018.
    • CMS Web Interface - Report between January 22 and March 22
    • Everyone else - Report by April 2.  

    Updates for 2019

    Reporting for the 2018 performance year must be completed by March 31, 2019.  At the same time, clinicians and groups need to begin working on their 2019 QPP reporting requirements now.

    Physicians can still choose from one of two payment tracks to avoid penalties and earn potential increases in Medicare payments—the Merit-Based Incentive Payment System or an Alternative Payment Model. Physicians, or their practices, have the opportunity to decide annually the program in which they will be participating.

    Do you qualify for 2019?Do you qualify for 2018?

     

    MIPS

    Merit-Based Incentive Payment System

    The Merit-Based Incentive Payment System (MIPS) builds on traditional fee-for-service payments by adjusting them based on a physician’s performance. Updated July 2018 to include 2017 Feedback Report information. Learn more

    APMs

    Alternative Payment Models

    Alternative Payment Models (APMs) are a new approach to paying for medical care that incentivizes quality and value. Some APMs will qualify as “Advanced APMs." Updated for 2018. Learn more

    Let ACP guide you through QPP

     

    Quality Payment Advisor

    Take advantage of ACP's Quality Payment Advisor® (QPA), a free online tool for ACP members that will indicate if you need to participate in the Quality Payment Program and what track you should be in. The QPA also identifies performance gaps and details specific actions to take to position your practice for success under the QPP.

     

    Create Free Account

     

    More information on QPP

    CMS Resources

    The Center for Medicare & Medicaid Services has both high level and detailed resources to assist you in navigating the rules and requirements and is easily sorted by program year, performance category, track (APM or MIPS), and resource type. Visit the CMS resource library below.

    See Resources

    MACRA News from ACP

    More MACRA News

     

    Have more questions?

    MACRA and the resulting Quality Payment Program are very comprehensive, and oftentimes confusing topics that affect all types of clinicians participating in Medicare Part B. If you still have questions or need further guidance, try these resources.

    10 Things You Should Know

    Frequently Asked Questions

    Glossary of Terms

    Additional Tools

    Printable Brochure

    2019 Printable Presentation

    For more information or questions or concerns regarding specific MACRA-related issues, email macra@acponline.org.

    We also encourage you to discuss MACRA with your colleagues in the Member Forum on MACRA.

    Quality Payment Program (QPP) for 2018

    Finalized in October 2016, the Quality Payment Program (QPP) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), officially replacing the old Sustainable Growth Rate system. The new QPP transforms Medicare physician compensation, moving away from fee-for-service billing and toward payment based on value.

    Understanding QPP is crucial for clinicians who participate in Medicare Part B. The below chart will help you determine if you quality for QPP.

    Do you qualify?

    YES
    NO
    Medicare Part B payments
    Medicare Part A (e.g., hospital payments)
    Physicians, PAs, NPs, CNSs, and CRNAs
    Clinicians that fall below the low-volume threshold*
    Groups that include the above clinicians
    Clinicians billing Medicare for the first year (for MIPS)

    *If you bill Medicare less than or equal to $90,000 a year OR provide care for less than or equal to 200 Medicare patients a year.

    If you do qualify to participate in QPP, you will need to decide which payment track to follow - the Merit-based Incentive Payment System or an Alternative Payment Model.

    After groups log into their EIDM account, they can click into a detailed listing of the eligibility status of every NPI in the group to find out if they are a 2018 MIPS participant.

    Quality Payment Program (QPP) for 2019

    Finalized in October 2016, the Quality Payment Program (QPP) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), officially replacing the old Sustainable Growth Rate system. The new QPP transforms Medicare physician compensation, moving away from fee-for-service billing and toward payment based on value.

    Understanding QPP is crucial for clinicians who participate in Medicare Part B. The below chart will help you determine if you quality for QPP in 2019.

    Do you qualify?

    YES
    NO
    Medicare Part B payments
    Medicare Part A (e.g., hospital payments)
    Physicians, PAs, NPs, CNSs, CRNAs, PTs and OTs, clinical psychologists, audiologists, speech & language pathologists, and registered dietitians or nutrition professionals.
    Clinicians that fall below the low-volume threshold*
    Groups that include the above clinicians
    Clinicians billing Medicare for the first year (for MIPS)

    *If you bill Medicare less than or equal to $90,000 a year OR provide care for less than or equal to 200 Medicare patients a year OR less than or equal to 200 professional services to Part B patients. However, clinicians or groups who qualify for one or two of the low-volume thresholds may "opt-in" to MIPS in 2019.

    If you do qualify to participate in QPP, you will need to decide which payment track to follow - the Merit-based Incentive Payment System or an Alternative Payment Model.

    Check your participation status in either MIPS or APM. After groups log into their EIDM account, they can click into a detailed listing of the eligibility status of every NPI in the group to find out if they are a 2018 MIPS participant.

    Please note that additional details regarding the 2019 performance year will be added as they become available.