COVID-19 Virus Resource

COVID-19 Updates and Resources

Connect with us for helpful information, product updates, and other resources to help your practice manage the challenges of COVID-19. STAY UP TO DATE!

What MACRA, MIPS mean for you

A trend has emerged in healthcare reimbursement: payments tied to quality, rather than quantity. MACRA encourages new strategies with the move to quality-based care.

What is MACRA?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the Sustainable Growth Rate and introduced the Quality Payment Program.

Intended results

Comprehensive care through two tracks: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

Effect on practices

How you get paid has changed. Rather than continuing a fee-for-service model of reimbursement, MACRA introduced the new payment paths.

So ... what is MIPS?

MIPS combines the former Physician Quality Reporting System (PQRS), Meaningful Use (MU), and the Value-based Modifier, which had final performance periods in 2016. It incorporates a new element called Clinical Practice Improvement Activities.

Each year, providers receive payment adjustments based on their performance in four categories — which are shown in the infographic here and described below.

DOWNLOAD THE INFOGRAPHIC

MIPS scoring categories

  • Quality: Formerly PQRS, this evaluates providers on their performance on clinical quality measures.
  • Cost: Formerly the Value-based Modifier, this evaluates providers on the cost of patient care. 
  • Advancing Care Information: Formerly Meaningful Use, this evaluates providers on how they use technology, with an emphasis on patient engagement and interoperability. 
  • Clinical Practice Improvement Activities: Clinical practices or processes that, according to the Secretary of Health and Human Services, will result in improved outcomes. For example, providing patients with 24/7 access to care.
DOWNLOAD OUR MACRA E-BOOK

Advanced APMs

Participation in Advanced Alternative Payment Models (APMs) exempts a provider or group from MIPS reporting and payment adjustments. These value-based contracts include an element of financial risk, such as shared losses. CMS encourages providers to participate in this track.

In 2017, Medicare Shared Savings Program tracks 2 and 3, Comprehensive Primary Care Plus (CPC+), and Next Generation Accountable Care Organizations (ACOs) were all included.

The rule will continue to evolve over time.

To learn more, check out this Greenway Health webinar.

We have a solution for every challenge

Technology and services that seamlessly span the front office, clinic, and billing office that help you deliver exceptional care and meet business goals.

Our MACRA knowledge is at your fingertips

Coronavirus relief: how the CARES Act can benefit healthcare providers. Illustration.
Greenway Blog

Coronavirus relief: CARES Act benefits for healthcare providers

Read More
Billing Practice Management_Charcoal
Podcast

Episode 70 - Serving Our Country, Our Customers, Our Community

Read More
Regulatory_Alt_Mint
Past Webinar

Proposed Quality Payment Program updates

Read More
Waste in healthcare spending. Illustration.
Greenway Blog

Tackle wasteful spending at the practice level

Read More

Partner with Greenway Health to stay informed about MACRA.

Schedule a free consultation