What are MACRA and MIPS?

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The Medicare Access and CHIP [Children's Health Insurance Program] Reauthorization Act (MACRA) was signed into law in April 2015. MACRA replaces the current Medicare reimbursement schedule with a new pay-for-performance program that's focused on quality, value, and accountability. According to the Centers for Medicare and Medicaid Services (CMS), under MACRA, healthcare providers will be rewarded for providing better care instead of more service-in other words moving from volume-based to quality-based pay. As a result, physicians and other referral sources will increase their focus on objective measures of care, which is a good indicator that O&P providers should consider developing such measures as well.

Specifically, MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into a new, single program called the Merit-based Incentive Payment System (MIPS).

MIPS will be used to determine Medicare payment adjustments. Using a composite performance score, eligible professionals could receive a payment bonus, a payment penalty, or no payment adjustment. The composite performance score is based on four performance categories:

  • Quality
  • Resource use
  • Clinical practice improvement activities
  • Meaningful use of certified electronic health records (EHR) technology

Scoring for MIPS performance will start January 1, 2017.