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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


Latest updates for 2018

Year two of the Quality Payment Program began on January 1, 2018. Clinicians and groups need to begin working on their 2018 QPP reporting requirements now. 

The Quality Payment Program (QPP) is the name for the Medicare Part B physician payment system that was established by the MACRA law. Beginning in 2017, physicians can 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 QPP?

 

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


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

Printable Powerpoint

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)

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 $30,000 a year OR provide care for less than or equal to 100 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.