MACRA Resource Center

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What is the MACRA Quality Payment Program?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare Sustainable Growth Rate formula that calculated payments for physicians. The MACRA Quality Payment Program creates a new framework for rewarding physicians for providing higher quality care. The Quality Payment Program will provide new tools and resources to help you give your patients the best possible care.

The Quality Payment Program has two tracks for participation:

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

The Quality Payment Program policy will reform Medicare Part B payments for more than 600,000 clinicians across the country, and is a major step in improving care across the entire health care delivery system.

Who participates in MIPS?

Medicare Part B clinicians billing more than $30,000 a year or providing care for more than 100 Medicare patients a year. These clinicians include:

  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists 

Who is excluded from MIPS?

  • Newly-enrolled Medicare clinicians: Clinicians who enroll in Medicare for the first time during a performance period are exempt from reporting on measures and activities from MIPS until the following performance year.
  • Clinicians below the low-volume threshold: Medicare Part B allowed charges less than or equal to $30,000 or 100 or fewer Medicare Part B patients.
  • Clinicians significantly participating in Advanced Alternative Payment Models (Advanced APMs): Clinicians participating in Advanced APMs earn greater rewards for taking on some risk related to their patients’ outcomes. The list of Advanced APMs is posted at QPP.cms.gov and will be updated with new announcements on ad hoc basis.

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