MACRA & QPP


Life before the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

Before MACRA was enacted, physicians and eligible clinicians were in a fee-for-service (FFS) payment system, where clinicians were paid based on volume of services, not value. As part of this FFS system, the Sustainable Growth Rate (SGR) formula was used to control the cost of Medicare payments to physicians. For example, if overall physician costs were greater than target Medicare expenditures then, physician payments were cut across the board. Each year, Congress passed temporary “doc fixes” to avert cuts.

Are you eligible?

Check your status with the QPP Participation Lookup Tool – https://qpp.cms.gov/participation-lookup.

 

Today: MACRA and the QPP

Authorized and funded by MACRA, the Quality Payment Program (QPP) ends the SGR formula and reforms Medicare Part B payments for more than 600,000 clinicians across the country. By taking this major step, CMS is working to improve care across the entire health care delivery system.

Two Tracks to Choose From

Eligible clinicians can choose how they want to participate in the QPP based on their practice size, specialty, location, or patient population.

Advanced APM

If you decide to take part in an advanced APM, you may earn a Medicare incentive payment for participating in an innovative payment model.

For more information about APMs.

Merit-based Incentive Payment System (MIPS)

If you decide to participate in traditional Medicare, you may earn a performance-based payment adjustment to your Medicare payments through MIPS.

For more information about MIPS.