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What is MACRA or Quality Payment Program (QPP) for Medicare Providers?

Updated: 06/23/2023|Views: 3231

MACRA stands for Medicare Access and CHIP Reauthorization Act and outlines the Quality Payment Program (QPP) coming into effect on January 1, 2017. MACRA replaces and consolidates previous incentive programs like PQRS and Meaningful Use under the new MACRA umbrella for Medicare providers.

MACRA has two tracks, Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

Quality ACOs
Promoting Interoperability Specialty Specific Programs
Improvement Activities State Specific Programs
Cost Multiple APM types

Eligible clinicians under MIPS will see Medicare payment adjustments ranging from 4% to 9% (negative or positive). Payment adjustments earned will depend on the final score earned on all four MIPS categories.

Eligible clinicians participating in an APM, may receive a payment adjustment and /or payment incentive based on the specific APM program requirements and how well they were met.

The following provider types are eligible to participate in the QPP:

  • Physician (Doctors of Medicine or Osteopathy, Doctors of Dental Surgery or Dental Medicine, Doctors of Podiatric Medicine, Doctors of Optometry, Chiropractors)
  • Physician Assistant
  • Nurse Practitioner
  • Clinical Nurse Specialist
  • Certified Registered Nurse Anesthetist
  • Physical Therapist
  • Occupational Therapist
  • Clinical Psychologist
  • Qualified speech-language pathologist
  • Qualified Audiologists
  • Registered dietitians or Nutrition Professionals

Clinicians are eligible if they are one of the provider types listed above AND meet or exceed the low-volume threshold:

  1. Bill Medicare over $90,000 in Part B allowed charges a year, and
  2. Provide covered professional services for more than 200 Part B-enrolled individuals, and
  3. Provide 200 or more covered professional services to Part B-enrolled individuals

Clinicians who do not meet or exceed the low-volume threshold now have the option to Opt-in or volunteer their MIPS data. Learn more about participation options here.

MACRA Eligibility

If you are eligible to participate in the QPP, you will participate via the MIPS or APM track or both. You might also be excluded from QPP altogether.

Find your eligible status by entering your NPI in the MIPS Participation Status page here.

To learn more about the MIPS and the APM tracks, click on the links below:

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