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Glossary Terms

What Is MACRA?

Glossary

The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law in 2015 based on years of feedback on how Medicare paid healthcare providers. While the government previously used a volume fee-for-service-based system, where physicians who performed the most services earned more. MACRA replaced the widely criticized sustainable growth rate (SGR) with the Quality Payment Program (QPP).

What Is MACRA?

The primary component of MACRA is the Quality Payment Program (QPP), which offers two payment tracks for healthcare providers. Both payment tracks aim to compensate physicians based on the quality and importance of their services, aligning with the overall goal of MACRA, which is to support better patient care and corresponding physician compensation. 

The QPP consists of MIPS and Advanced APMs, and physicians can choose one of the two to determine how Medicare will pay them for the services they deliver to eligible patients. The Merit-Based Incentive Payment System (MIPS) adjusts the size of the payment a provider receives based on performance, which is scored across four categories: quality, cost, promoting interoperability, and improvement activities.

Meanwhile, the Advanced Alternative Payment Model (AAPM) track incentivizes quality and cost-effective care. There are currently six AAPMs that primary care providers can select from that are primarily associated with ACOs. However, most physicians will need to adhere to MIPS reporting guidelines, as MIPS is the more popular of the two options. 

Tips for MIPS Reporting 

The best way to maximize your payments is to ensure quality clinical care and have thorough and accurate reporting. 

  • Even when reporting as a group, scores are attached to individual national provider identifiers (NPIs).
  • If the provider changes groups between the performance period and payment year, payment adjustments from the previous group/period will remain in effect.
  • MIPS performance may be used to determine physician compensation. As such, better MIPS performance should lead to additional compensation.
  • Just as employers should consider a physician's MIPS scores, a physician should consider a practice's MIPS scores before joining. 

Additional information on MIPS reporting can be found on the QPP website

How TempDev Can Help With MACRA

TempDev’s team of experienced consultants, developers, and trainers is here to support enhanced accessibility and customized features and templates. This enables you and your patients to have more control over data with improved transparency. 

As part of our streamlining process, we help you implement the Patient Portal, API, and other tools to better support safety, patient engagement, and security. TempDev offers the comprehensive resources and tools you need to ensure compliance from dashboards to automation and workflow redesign. 

Contact us here or by calling us at 888.TEMP.DEV to ensure you're receiving the most from the QPP.

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