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January 23, 2023

Succeeding Under MACRA: What Practices Need to Know

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Medical Practice

Well, we all know that the Centers for Medicare and Medicaid Services (CMS) released the final rule - MACRA (the Medicare Access and CHIP Reauthorization Act). Many practices are concerned and worried about what MACRA means for their practice. Of course, the transition to value-based care delivery and payment methods presents many challenges for practices, the following are a few things that help practices and clinicians succeed under MACRA.

Navigating MACRA

MACRA’s Quality Payment Program transforms Medicare reimbursement from pay-for-service to Pay-for-performance through two payment models - the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). According to CMS, the goal of the Quality Payment Program is to offer providers new tools, and resources to help deliver the quality patient care. The program is intended to enable practices to focus more on value-based care.

MIPS consolidates CMS quality reporting programs into one program that eliminates the clinical burden and encompasses performance categories such as quality, resource use, practice improvement activities and advancing care information. It is important to eliminate the administrative burden today’s physicians have so that they can concentrate more on delivering high-value, high-quality patient care to achieve significant benefits from value-based reimbursement under MACRA.

MIPS Reporting Options

Practices will have four reporting options under MIPS:

  • Practices that do nothing will incur a 4% penalty
  • Do the minimum: Practices can test their system by reporting for a minimum 90 days on atleast one quality measure, one CPIA activity, or the required ACI measures. Doing this will avoid a minimum negative adjustment for practices.
  • Practices that report more than the minimum number of measures for 90 days will completely avoid a negative adjustment and may receive a small positive adjustment.
  • Practices that report for the full year will receive a positive adjustment upto 4%.

Avoiding Negative adjustments under Medicare Part B payments

Participating in the Merit-Based Incentive Payment System (MIPS) is the best way for practices to avoid negative adjustments in their Medicare payments and earn positive adjustments.

Amendments to MIPS scoring categories

CMS reduced the requirements for participating in the new MACRA program:

Clinical Practice Improvement Activities (CPIA)

Practices need to earn only 40 points to fully participate in this category, while small & rural practices have to earn only 20 points, which means full participation requires four medium-priority activities instead of six or two high-priority activities instead of three. On the other hand, small and rural practices have to complete only two medium-priority activities or one high-priority activity.

Advancing Care Information (ACI)

Practices need to complete only five measures instead of 11. Other requirements such as Immunization registries, specialty registries, and public health reporting registries are not required, however, they add bonus points to your ACI score.


The cost has been reduced from 10% to 0% of practice score so as to let physicians know how cost could impact their reimbursement in the future.

Certified Electronic Health Record System (EHR) can help practices successfully participate in quality reporting programs such as Meaningful Use and the Physician Quality Reporting System. As quality reporting continues to evolve, this is the right time for practices to deploy EHR systems and succeed under MACRA.

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