Reimbursement Resources

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signing into law in 2015 and permanently eliminated the sustainable growth rate (SGR). MACRA aims to reward high value, high quality Medicare clinicians with payment increases and simultaneously reducing payments to those clinicians who aren’t meeting performance standards.

Clinicians have two tracks to choose from in the Quality Payment Program (QPP) based on their practice size, specialty, location or patient population:

  • Merit-based Incentive Payment System (MIPS)
    • Clinicians earn performance-based payment adjustments for services provided to Medicare patients
  • Advanced Alternative Payment Models
    • Customized payment approach developed by CMS, designed to provide incentives to clinicians who are providing high-quality, high value care. APMs can focus on specific clinical conditions, care episodes or populations