MACRA, MIPS and Your Role

MACRA, MIPS and Your Role


MACRA stands for Medicare Access and CHIP Reauthorization Act. It was approved by President Obama on April 16, 2015. The importance of the bill is indicated by its value within healthcare reform through legislative support at the House of Representatives and the Senate.

MACRA is a replacement for the current reimbursement schedule for Medicare. The new program focuses on a broader push towards care quality and value, often referred to as “pay-for-performance.” The Centers for Medicare and Medicaid Services (CMS) replaced the “fee-for-service” framework to incentivize health care providers based on the quality of care provided to patients.

Currently, there are multiple individual payment programs that are, Physician Quality Reporting System, Value-based Payment Modifier and Medicare Electronic Health Record incentive program. MACRA has streamlined all these individual programs into a single program called Merit-based Incentive Payment System (MIPS).


Merit-Based Incentive Payment System (MIPS) is what determines the reimbursement from Medicare. It will use a composite performance score. Based on the MIPS score ranging from 0-100, physicians and providers can get a bonus, penalty or no adjustments. These adjustments can affect reimbursement from anywhere between -9 to +27 percent in the next 5 years. This payment system does not apply to hospitals or facilities.

The Composite Performance Score factors in four weighted performance categories. The weights for each of these categories will vary over time to increase focus on any of the aspects that may be found to be lacking behind.

What you can do

The first recommended step that can easily be achieved is Meaningful Use Stage 3 (MU-3) and the PQRS factors. Meaningful Use requirement is covered by your EHR vendor and therefore, you should make sure EHR is MU-3 certified which although currently optional, will be required in 2018. There are EHRs that also incorporate clinical practice improvement activities that you can keep a track off. Along with that, providers can continue working on achieving PQRS requirements which some EHRs can help you achieve. talkEHR will support and help you meet the requirements of the program to help your practice receive the reimbursements it deserves.

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