Macra & Mips

What is MACRA?

Medicare Access and CHIP Reauthorization Act (MACRA) establishes a new pay-for-performance program that’s focused on quality, value, and accountability. The law was signed on April 16, 2015. The Centers for Medicare and Medicaid Services (CMS) stated that MACRA enacts a new payment framework called the Quality Payment Program that rewards health care providers for giving better care instead of more service.
MACRA combines parts of the

incentive program into one single program called the Merit-based Incentive Payment System, or “MIPS”.

Quality Payment Program

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate (SGR) formula, which would have significantly cut payment rates for participating Medicare clinicians. MACRA requires us to implement an incentive program, the Quality Payment Program (QPP). The QPP improves Medicare by helping eligible clinicians focus on care quality and making patients healthier. This program is the latest in a series of steps the Centers for Medicare and Medicaid Services (CMS) has taken to incentivize high quality of care over service volume.

The Quality Payment Program went into effect on January 1, 2017 and has two paths for participation:

The Merit-based Incentive Payment System (MIPS)

Advanced Alternative Payment Models (APMs)

What is MIPS

Effective January 1, 2017, Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM) will be consolidated into the new Merit-based Incentive Payment System (MIPS). This is one of the two tracks under the Quality Payment Program. MIPS streamlines the financial impact of the various measurement and reporting tools, along with claims-based financial considerations that have become familiar since the adoption of digital health records.

Provider performance will be measured which will influence Medicare reimbursement payments each year. The four categories that will be used to measure performance are: Quality, Promoting Interoperability, Cost and a new category called Improvement Activities.

Eligible Clinicians

For the reporting years 2017 and 2018 (impacting reimbursements in 2019 and 2020), the following providers are MIPS-eligible clinicians: physicians, physician assistants, nurse practitioners, clinical nurse specialists, and nurse anesthetists. In 2019, the pool of eligible clinicians expands considerably.

All Medicare Part B providers who meet the definition of a MIPS ELIGIBLE CLINICIAN should plan to participate in MIPS in 2017 or they will be subject to a negative 4% payment adjustment on Medicare Part B reimbursements in 2019.

What is financial Impact for participating or reporting MIPS in 2019?

  • Can Avoid 7% Medicare Penalty in 2021.
  • Can gain 7% Medicare incentive in 2021.
  • Can also gain incentive from top performer slab.

How Our Certified Consultant can help you?

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Step 1

Review the Current relevant data.

Step 2

Decide on reporting mechanism like EHR, Claim or Registry.

Step 3

Construct the Road map contains targeted reporting period and score.

  1. Data Analysis.
  2. Measure selection.
  3. Selection of reporting option.
  4. Selection of reporting mechanism.
  5. Submission of data to CMS certified registry
  1. Eligibility Analysis: A session where our consultant analyses provider’s eligibility and potential payment schedules.
  2. Measure Selection: A session where consultant will finalize and 5 base measures and also other measures in case of incentive.
  3. Gap Analysis: A customized meaningful use gap analysis outlining the deficiency in meaningful use measures.
  4. Training / Followup: Provide customized training in order to meet each measure and give regular follow-up.
  5. Attestation: Consultant will do the attestation and claim applicable exclusion.
  6. Audit: Prepare the doctor(s) for Audit. In case of Audit, consultant will assist the doctor(s) to pass the audit.
  1. Measures selection
  2. Guidance and training to collect relevant data
  3. Submission of data to CMS through registry
  4. Audit support
  1. CMS will calculate cost measure performance; no action is required from clinicians.

We are certified registry

Who is eligible to Participate?

If you are one of them:

And Collects at-least $90,000 from Medicare per year.

You can also check your eligibility on by putting individual NPI at

HPA offers consulting services to all the Hospitals, group practices, and individual providers. We use our education and expertise to work for you.