Frequently Asked Questions: Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

MACRA is here and we know you have questions. Here are a few frequently asked questions on MACRA and Medicare Payment Reform.

What is MACRA?

MACRA is the Medicare Access and CHIP Reauthorization Act, law passed on April 16, 2015.

Medicare Access and CHIP Reauthorization Act now replaces the current Medicare reimbursement schedule with a new pay-for-performance program that’s focused on quality, value, and accountability.

MACRA now consolidates all the following: Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, or “MIPS”.

How does the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact my Medicare payments?

MACRA impacts Medicare payments in three ways. The law:

  • Repeals the flawed Medicare sustainable growth rate (SGR) formula that calculated payment cuts for physicians.
  • Creates a new framework for rewarding physicians for providing higher quality care by establishing two tracks for payment:
    • Merit-based Incentive Payment System (MIPS), and
    • Alternative Payment Models (APMs)
  • Combines three existing quality reporting programs (Physician Quality Reporting SystemValue-based Payment Modifier, and meaningful use), plus adds a new performance category, into a single system through MIPS.

How does MACRA help small practices?

$20 million a year is allocated to provide technical assistance to practices with 15 or fewer eligible clinicians participating in MIPS. Priority will be given to practices in rural areas, health professional shortage areas (HPSAs), and medically-underserved areas.

For practices that do not qualify for the MACRA technical assistance, there are other options such as the Transforming Clinical Practice initiative (TCPi). This program was launched to position practices for participation in alternative payment models.

What can I do now to prepare for MACRA implementation?

The first year for MACRA is 2019, we still have time, but we need to act fast. Sources anticipate that performance in 2017 may determine payments for the first year of MIPS in 2019.

Sources say, “if you haven’t reported data on quality measures through the Physician Quality Reporting System (PQRS) or as part of meaningful use, start as soon as possible. Negative payment adjustments for not reporting or for low quality may impact you this year.”

Sources also say” If you submitted quality data during the last calendar year, you should access your Quality and Resource Use Report (QRUR). This report will help you understand your performance in terms of cost and quality so you can prioritize potential areas for improvement. The AAFP has created a MACRA Readiness Assessment to walk you through steps you can take to prepare for MIPS.

If your practice doesn’t provide chronic care management (CCM) services, consider the cost-benefit opportunity for increasing revenue to support needed practice transformation or quality improvement projects. Medicare began paying for CCM codes on January 1, 2015.”

Our sources have great information about MACRA, it may not be 2019 just yet, but it’ll be here sooner than you know it.

All of this great information was from the AAFP. (American Academy of Family Physicians)