MACRA is an act that requires CMS to implement the Quality Payment Program in which you can participate via either MIPS or Advanced APMs. MIPS combines the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals, the Physician Quality Reporting System, and the Value-Based Payment Modifier into a single, improved program. To learn more, read along!


What is MACRA?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to implement an incentive program — the Quality Payment Program — which provides two participation tracks for clinicians:


Merit-based Incentive Payment System (MIPS)

In MIPS, three legacy programs — Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals, Value-Based Payment Modifier, and the Physician Quality Reporting System — are combined into a single, improved program.


The Four Pillars of MIPS Reporting

In MIPS, there are four connected factors that affect how Medicare will pay eligible providers:

  • Quality
  • Improvement Activities
  • Advancing Care Information
  • Cost


Under MIPS, the provider’s performance is evaluated across the above four categories that lead to improved quality and value in the healthcare system.


There are specific reporting requirements in three of these categories, where certified EHR technology can be a major asset in capturing, calculating, and submitting information.


If you’re eligible for MIPS, the following applies:

·         You have to submit data for the Quality, Improvement Activities, and Promoting Interoperability performance categories. (No data submission is required for Cost performance category.)

·         Your performance across the MIPS performance categories — each with a specific weight — will result in a MIPS final score of 0 to 100 points.

·         Your MIPS final score will determine whether you receive a negative, neutral, or positive MIPS payment adjustment.

·         Your MIPS payment adjustment is based on your performance during the 2021 performance period and will be applied to payments for covered professional services beginning on January 1, 2023.


What are the MIPS Eligibility Criteria?


Clinicians who are eligible for MIPS are as follows:

  • Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry)
  • Osteopathic practitioners
  • Chiropractors
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Physical therapists
  • Occupational therapists
  • Clinical psychologists
  • Qualified speech-language pathologists
  • Qualified audiologists
  • Registered dietitians or nutrition professionals


Low-Volume Threshold Criteria for 2021:

·         Bill more than $90,000 for Part B covered professional services under the Physician Fee Schedule

·         See more than 200 Part B patients

·         Provide more than 200 covered professional services to Part B patients

All three criteria must be met.


Submission Methods

There are multiple ways to report data to CMS, but how you choose to report and which methods are available to you depend on:

  • The size of your practice
  • The type of information technology you use
  • The performance category you’re reporting
  • Whether you belong to a group


MIPS Performance Period and Payment Adjustments


2020 MIPS Eligible clinicians must report performance data till 03/31/2021.


2021 MIPS Eligible clinicians must start collecting data starting 01/01/2021.


Contact WCH if you need support in MIPS program!



Source: https://qpp.cms.gov/