The Medicare Access and CHIP Reauthorization Act (MACRA) is a bipartisan legislation that was passed into law in April 2015 which changed the way physicians are reimbursed for Medicare Part B beginning January 1, 2017.  MACRA repealed the flawed Sustainable Growth Rate (SGR) formula and replaced it with the Quality Payment Program (QPP), under which clinicians have the opportunity to earn bonuses or face penalties in the form of positive, neutral or negative payment adjustments based on their performance in the QPP.

Currently, the QPP requires physicians to use one of two paths for value-based reimbursement:
the Merit-based Incentive Payment System (MIPS)
or Advanced Alternative Payment Models (APMs).

Read AANEM’s summary of the 2023 QPP rule.  
 

The Merit-based Incentive Payment System

The MIPS program combined parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) incentive program into a single platform through which eligible clinicians are measured in 4 different areas:

• Quality
• Promoting Interoperability
• Cost
• Improvement Activities

Each of these different areas account for a specific percentage of the total score of 100%.  Your performance in 2023 in these four categories will generate a score that will determine payment adjustments in 2025.  To avoid a penalty in 2025, you must score 75 points across all four categories.
 

Advanced Alternative Payment Models

The second pathway through which clinicians can participate in the QPP is through an Advanced Alternative Payment Model (APM).  An APM is a payment approach that provides incentive payments to clinicians for providing high-quality, cost-effective care.  APMs can apply to a specific disease, care episode or patient population.

 

Additional Information

Traditional MIPS Category Requirements:

• Quality Performance Category
• Promoting Interoperability Measures
• Improvement Activities Performance Category
• Cost Performance Category

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If you have questions, please contact the Policy Department at policy@aanem.org