For this entry, we are going down the acronym rabbit hole, to explain MIPS and MACRA and describe the advantages of the program(s). Often used in tandem or interchangeably, the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act, also known as MACRA, is the law that brought MIPS (the Merit-based Incentive Payment System) into effect. We will lay out the intents of each and how they can benefit – or penalize – providers.

What is the intent of MACRA?

MACRA was signed into law on April 16, 2015, and is a value-based payment model.1 Specifically, it changes the way that Medicare rewards clinicians for value over volume, by significantly changing how the federal government pays physicians. “Passage of the law permanently repealed the flawed sustainable growth rate (SGR) and set up the two-track Quality Payment Program (QPP) that emphasizes value-based payment models. Under MACRA, Medicare and other payers are increasingly paying physicians based on the value rather than the volume of their services.2

What is MIPS?

The website for The American Academy of Physical Medicine and Rehabilitation succinctly defines the Merit-based Incentive Payment System (MIPS) as, “the program that will determine Medicare payment adjustments. Using a composite performance score, eligible clinicians (ECs) may receive a payment bonus, a payment penalty or no payment adjustment.3” It is comprised of the following parts:

  • Quality—replaces Physician Quality Reporting System (PQRS) program
  • Cost—replaces value-based modifier (VBM) program
  • Promoting Interoperability (PI)—replaces Meaningful Use (MU) program
  • Improvement Activities4

The composite scoring referenced above, has seen increases in both the penalties and bonuses awarded, since 2019. For the current year they stand at a maximum penalty of up to 9%, with bonuses of up to 9% or more from the Medicare payments calculated.

How Does MACRA and MIPS impact providers?

Along with the shift from volume to value, there were increased reporting requirements. In multiple surveys taken in years after the program was enacted, providers indicated that they were unprepared for the demands.5-8 In fact, the reporting requirements were the main cause for concern, and in one survey, “Only 8% of the doctors said they are very prepared for long-term financial success under the program.6” With the concerns focused squarely on the reporting, 90% of respondents in one survey characterized that aspect of the law as burdensome.

A proven, tested choice for MACRA/MIPS assistance

As the dust settled around the initial MACRA and MIPS confusion, it was clear that regulatory reporting could be burdensome – and costly,9 if not done in a timely and accurate way. Advantum Health offers its own program to ensure that the labyrinth of regulations is successfully and profitably navigated. WRAPSTM (Wellness & Revenue Assistance Program TM) offers guidance and advice to providers as they engage with MACRA’s quality payment programs. Based on a 100% successful attestation rate for “Meaningful Use” in our customer base, along with expert training, and quality control services for PQRS, Advantum Health has the experience and proven results that providers trust. Furthermore, WRAP is an ongoing consultative and advisory service that delivers education, best practices, registration, performance analysis oversight to prepare for and thrive in value-based care. WRAP offers:

  • 5%-15%+ revenue improvement in most engagements.
  • Avoidance of MIPS payment penalties, as based on previous years’ performance.
  • Full analysis of current state programs, patient population, and systems with recommendations for enhancements.

These objectives allow providers to spend more time focused on patients and revenue, not regulatory compliance.

Contact us today to learn how the experts at Advantum Health can assist with your regulatory reporting, and how you can increase profitability with the MACRA/MIPS requirements.


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