MACRA: MIPS and APMs Compliance

The Medicare Accessibility and CHIP Reauthorization Act (MACRA), signed into law in April 2015, introduced several changes to the physician reimbursement framework. MACRA replaced the Workable Growth Rate formula with the Quality Payment Program (QPP) to provide incentives payments that emphasize the value and quality of care over the volume. The QPP includes three existing quality reporting programs (PQRS, Value-Based Payment Modifier and Medicare EHR Incentive Program/Meaningful Use) and adds a fourth category, Improvement Activities, into one program.

Under the QPP physicians can participate in either the Merit-based Incentive Payment System (MIPS) or in Advanced Alternative Payment Models (APMs) to avoid descending payment adjustments and potentially receive upward adjustments.

MIPS Payment Adjustments

MIPS is designed to be budget neutral, with upward and downward adjustments balanced so that the average change is 0% across reimbursement.

Performance is measured on a calendar year basis, with payment adjustments made one year after the performance measurement period. For 2018, the payment adjustment will be -5% to +5%, paid out in 2020. The range of payments will increase annually to +/- 9% for the 2020 measurement year, paid out in 2022.

The Challenge Ahead

Nobody ever suggested that repealing the hopelessly damaged SGR formula would be easy. MACRA has its own set of defects. The main problem with MACRA implementation at this point is that the regulation assumed a health care infrastructure in terms of meaningful performance measures, access to relevant data, and viable APMs that does not yet exist.
Policy makers should make MIPS less onerous by ranging the current reporting flexibility. At the same time, access to APMs should be accelerated by leveraging innovations in the private sector, particularly those in Medicare Advantage.


Currently we are partners with software vendors and using more than 25 software in-house for billing and offer the training sessions if required by the clients. We are developing our ultimate products and will notify you when established and tested. Few Questions you need to focus on while signing up with a billing company;

How well does it integrate with my EMR?

If your RCM software unable to communicate with your documentation platform, that’s an immediate deal breaker. So, before you sign on the dotted line, make sure your billing software can integrate with your EMR if you are using any and remember, not all integrations are created equal, so dig for details. At least, the integration should make it possible to transmit the following information from your EMR to your billing software:

  • ICD-10 and CPT codes
  • Provider information
  • Patient demographics
  • Patient payments
  • Insurance profiles
  • Referring physicians

Catch RCM Barriers

Additionally, any system you choose for your practice should have built-in reporting tools that make self-auditing a breeze and help you catch inefficiencies in your practice.

Do you offer training for new clients?

When you make a commitment as substantial as implementing a new software, you want to make sure you and the individual handling your cash flow actually know how it works. Find out how many training sessions you’ll get, and be wary of hidden fees for initial training services. The cost of new-client training should be included in your initial setup amount and that’s the only surprise expense.

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