Are You Ready for MACRA/MIPS?


The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is intended to rapidly push the transformation of the US healthcare system toward performance-based payment models across both government and commercial payers. The law provides strong incentives to physicians for participation in Medicare risk-sharing Alternative Payment Models (APMs). For physicians who choose not to become involved in APMs, they will be required to report and perform well on four categories – quality, advancing care information, improvement activities and cost.

Bearing risk and reporting on clinical performance requires the ability to collect, analyze and report on clinical performance data. Whether it is identifying high cost patients, reducing readmissions and adverse events, coordinating care and managing resource use, or accurately reporting quality measures to various registries and payers, clinicians will need to make better use of health information technology to help them avoid financial penalties and allow their practices to prosper in the new environment.

Are you required to submit data to the Quality Payment Program also known as MIPS?
  • To find out if you are eligible, go to https://qpp.cms.gov/participation-lookup and type in your NPI number.
  • This tool will display MIPS eligibility based on a TIN and NPI combo. For physicians who work at multiple facilities with different TIN’s, it’s possible that those physicians could be required to submit MIPS data from multiple locations.
Why it’s important to learn about your MIPS eligibility
  • Your 2018 MIPS performance determines your 2020 Medicare payment adjustment of up to +/-5%
  • Your MIPS performance will be made publicly available via physician compare
What to do if you find out that you are eligible for the Quality Payment Program/MIPS
  • To avoid a -5% Medicare payment adjustment in 2020, you will need to submit your 2018 MIPS data to CMS by March 31, 2019 and receive a MIPS score of at least 15.
  • MIPS final scores are determined based off of performance in the following categories:
    • Quality (50% of MIPS score)
    • Promoting Interoperability (25% of MIPS score)
    • Improvement Activities (15% of MIPS score)
    • Cost (10% of MIPS score)


CLICK HERE to access physician payment reform resources from CMS.