FAQ on MACRA and Medicare Payment Reform

FAQ on MACRA and Medicare Payment Reform

Frequently Asked Questions: Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

Key:

*Indicates a question has significantly changed since the last update.

+Indicates a new question added to the FAQ.

What is the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)?*

At a very high level, MACRA:

  • Repeals the flawed Medicare sustainable growth rate (SGR) formula that calculated payment cuts for physicians;
  • Creates a new framework for rewarding physicians for providing higher quality care by establishing two tracks for payment: 
    • Merit-based Incentive Payment System (MIPS), and
    • Advanced Alternative Payment Models (AAPMs); and

Download a timeline of important MACRA dates »(1 page PDF)

The AAFP has created an introductory, on-demand series for members to provide an overview of the Quality Payment Program (QPP) and how it will affect your practice. Watch the series now »

What is the Quality Payment Program (QPP) and how does it relate to MACRA?+

The Quality Payment Program (QPP) is the umbrella term used to describe the MIPS and AAPM tracks under MACRA.

What is the Merit-based Incentive Payment System (MIPS)?*

The Merit-based Incentive Payment System (MIPS) consolidates three existing quality reporting programs: the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VBPM), and meaningful use (MU). The system also adds a new performance category, called improvement activities (IA). Scores from the four categories are combined to establish a final score (0-100) that will be compared against a threshold. The final score is then used to determine physician payment adjustments. The categories that make up the MIPS final score are:

  • Quality—based on PQRS;
  • Resource use—based on VBPM;
  • Advancing Care Information (ACI)—based on MU; and
  • Clinical practice improvement activities—new performance category.

AAFP members can watch a short primer on MIPS, titled "MACRA: An Overview of the Merit-based Incentive Payment System (MIPS)." Watch the on-demand module now »

How will I be scored under MIPS?*

Scores for each performance category will be weighted and rolled up into the MIPS final score. The weights of each category shift over the course of the program.

Performance Category

2019

2020

2021

Performance Category

:

Quality

2019

:

60%

2020

:

50%

2021

:

30%

Performance Category

:

Cost

2019

:

0%

2020

:

10%

2021

:

30%

Performance Category

:

ACI

2019

:

25%*

2020

:

25%*

2021

:

25%*

Performance Category

:

IA

2019

:

15%

2020

:

15%

2021

:

15%

*If the Secretary of the U.S. Department of Health and Human Services (HHS) determines the proportion of eligible clinicians who are “meaningful users of electronic health records (EHRs)” is estimated at 75% or greater, the weight of the ACI category may be reduced. The remaining performance categories will be increased by the corresponding number of percentage points. The lowest weight the ACI category can carry is 15%.

Who am I compared to?

All MIPS-eligible clinicians (ECs), regardless of specialty, will be compared to each other and against a performance threshold.

What if I am in a large multispecialty group?+

ECs in a large multispecialty group can report either as an individual or as a group. When reporting as a group, all ECs reporting under the group’s tax identification number (TIN) will be included. A group cannot have some ECs report as a group and others report as individuals. Under the group reporting option, all ECs will report on the same measures. If you choose to report as a group, you must report as a group across all four MIPS performance categories.

What are the reporting methods?+

Reporting methods for individuals include: claims, qualified clinical data registry (QCDR), qualified registry, and electronic health records (EHR). The ACI and IA categories will include attestation options. There is no data submission for the cost performance category, as the Centers for Medicare & Medicaid Services (CMS) will calculate this for ECs based on Medicare claims data.

Reporting methods for groups include: QCDR, qualified registry, EHR, CMS Web Interface, and CMS-approved survey vendor for the Consumer Assessment of Health Providers and Surveys (CAHPS) for MIPS. Groups will also be able to attest for the ACI and IA performance categories. The CMS Web Interface option is only available to groups of 25 or more ECs.

What are the reporting requirements under MIPS?*

Quality

In the quality performance category, you must report at least six measures, including one outcome measure. Measures previously available under the PQRS program will be available in the quality category of MIPS.

In addition to the six measures reported by ECs, CMS will calculate the all-cause hospital readmissions measures for groups of 16 or more ECs. This measure was previously included in the VBPM program.

Cost

There is no reporting requirement for ECs under the cost category. CMS will calculate the clinician’s performance using claims data. During the transition year (2017), the cost performance category has been reweighted to 0%. Beginning with performance year 2018 (for payment year 2020), clinicians will be assessed on their performance of total per capita costs and Medicare spending per beneficiary (MSPB). Clinicians will also be assessed on applicable episode-based measures. To help clinicians become familiar with cost measures, CMS will provide feedback on these measures during the transition year.

To understand your previous performance compared to current national performance in quality and cost, review your Quality and Resource Use Report (QRUR).

Improvement Activities (IA)

Patient-centered medical homes (PCMH) will automatically receive full credit in the IA category. Organizations which currently offer approved PCMH accreditation include:

  • National Committee for Quality Assurance (NCQA)
  • Accreditation Association for Ambulatory Health Care (AAAHC)
  • Joint Commission (previously called the Joint Commission on Accreditation of Healthcare Organizations)
  • URAC (previously called the Utilization Review Accreditation Commission)
  • State-based, regional, private payers, or other entities that administer PCMH accreditation to at least 500 practices

Additionally, if one practice under the TIN has PCMH recognition, the entire TIN will qualify for full points with the IA performance category.

Clinicians who do not qualify for the automatic full credit must attest to two high-weighted (20 points each) or four medium-weighted (10 points each) activities, or a combination of both to achieve a total of 40 points. CMS has a list of more than 90 improvement activities. An activity must be performed for at least 90 days during the performance period to receive credit.

In order to ease the burden for small practices (15 or fewer ECs), practices in rural areas or health professional shortage areas (HPSAs), CMS is only requiring submission of one high-weighted activity or two medium-weighted activities.

If you are an EC that is an APM, but not a MIPS APM, you will receive half the credit for the IA performance category.

For MIPS APMs, CMS will assign a score in the IA performance category based on IA requirements under the terms of the particular MIPS APM. If CMS assigns the maximum score, then MIPS APM participants would not need to submit additional activities. If the MIPS APM does not receive the maximum score, the participants would have the opportunity to submit additional activities to be added to the baseline score assigned to CMS.

Advancing Care Information (ACI)

ECs will receive a base score and performance score in the ACI performance category. The base score accounts for 50% of the ACI performance category score and clinicians can earn the additional 50% through their performance score. An EC cannot earn more than 100 points (100%) in the ACI performance category.

For the base score, clinicians must report a numerator (of at least one) and denominator, or yes or no (only yes would qualify for credit) for each required measure within a subset of objectives. Failure to meet the criteria for any of the base score measures would result in a zero for the base score and ultimately a zero for the entire ACI performance category score.

If the base score is achieved, the performance score enables clinicians to earn up to 50 points (based on their performance rate) toward their overall ACI performance category score.

The objectives and measures are based on the 2015 EHR Incentive Program requirements. In 2017, a clinician can use 2014 edition certified EHR technology (CEHRT), 2015 edition CEHRT, or a combination of the two. All clinicians must be on the 2015 edition of CEHRT beginning with the 2018 performance period.

Clinicians using EHRs certified to either the 2014 or the 2015 edition can report on the following objectives and measures:

2017 Advancing Care Information Transition Objective (2017 Only)

2017 Advancing Care Information Transition Measure (2017 Only)

Required/Not Required for Base Score

Performance Score

Reporting Requirement

2017 Advancing Care Information Transition Objective (2017 Only)

:

Protect Patient Health Information

2017 Advancing Care Information Transition Measure (2017 Only)

:

Security Risk Analysis

Required/Not Required for Base Score

:

Required

Performance Score

:

0

Reporting Requirement

:

Yes/No Statement

2017 Advancing Care Information Transition Objective (2017 Only)

:

Electronic Prescribing

2017 Advancing Care Information Transition Measure (2017 Only)

:

e-Prescribing

Required/Not Required for Base Score

:

Required

Performance Score

:

0

Reporting Requirement

:

Numerator/Denominator

2017 Advancing Care Information Transition Objective (2017 Only)

:

Patient Electronic Access

2017 Advancing Care Information Transition Measure (2017 Only)

:

Provide Patient Access

Required/Not Required for Base Score

:

Required

Performance Score

:

Up to 20%

Reporting Requirement

:

Numerator/Denominator

2017 Advancing Care Information Transition Objective (2017 Only)

:

View, Download, or Transmit (VDT)

2017 Advancing Care Information Transition Measure (2017 Only)

:

Not Required

Required/Not Required for Base Score

:

Up to 10%

Performance Score

:

Numerator/Denominator

2017 Advancing Care Information Transition Objective (2017 Only)

:

Patient-specific Education

2017 Advancing Care Information Transition Measure (2017 Only)

:

Patient-specific Education

Required/Not Required for Base Score

:

Not Required

Performance Score

:

Up to 10%

Reporting Requirement

:

Numerator/Denominator

2017 Advancing Care Information Transition Objective (2017 Only)

:

Secure Messaging

2017 Advancing Care Information Transition Measure (2017 Only)

:

Secure Messaging

Required/Not Required for Base Score

:

Not Required

Performance Score

:

Up to 10%

Reporting Requirement

:

Numerator/Denominator

2017 Advancing Care Information Transition Objective (2017 Only)

:

Health Information Exchange

2017 Advancing Care Information Transition Measure (2017 Only)

:

Health Information Exchange

Required/Not Required for Base Score

:

Required

Performance Score

:

Up to 20%

Reporting Requirement

:

Numerator/Denominator

2017 Advancing Care Information Transition Objective (2017 Only)

:

Medication Reconciliation

2017 Advancing Care Information Transition Measure (2017 Only)

:

Medication Reconciliation

Required/Not Required for Base Score

:

Not Required

Performance Score

:

Up to 10%

Reporting Requirement

:

Numerator/Denominator

2017 Advancing Care Information Transition Objective (2017 Only)

:

Public Health Reporting

2017 Advancing Care Information Transition Measure (2017 Only)

:

Immunization Registry Reporting

Required/Not Required for Base Score

:

Not Required

Performance Score

:

0 or 10%

Reporting Requirement

:

Yes/No Statement

2017 Advancing Care Information Transition Objective (2017 Only)

:

Syndromic Surveillance Reporting

2017 Advancing Care Information Transition Measure (2017 Only)

:

Not Required

Required/Not Required for Base Score

:

Bonus

Performance Score

:

Yes/No Statement

2017 Advancing Care Information Transition Objective (2017 Only)

:

Specialized Registry Reporting

2017 Advancing Care Information Transition Measure (2017 Only)

:

Not Required

Required/Not Required for Base Score

:

Bonus

Performance Score

:

Yes/No Statement

Clinicians using technology certified to the 2015 edition can report the following objectives and measures.

Advancing Care Information Objective

Advancing Care Information Measure

Required/Not Required for Base Score

Performance Score

Reporting Requirement

Advancing Care Information Objective

:

Protect Patient Health Information

Advancing Care Information Measure

:

Security Analysis

Required/Not Required for Base Score

:

Required

Performance Score

:

0

Reporting Requirement

:

Yes/No Statement

Advancing Care Information Objective

:

Electronic Prescribing

Advancing Care Information Measure

:

e-Prescribing

Required/Not Required for Base Score

:

Required

Performance Score

:

0

Reporting Requirement

:

Numerator/Denominator

Advancing Care Information Objective

:

Patient Electronic Access

Advancing Care Information Measure

:

Provide Patient Access

Required/Not Required for Base Score

:

Required

Performance Score

:

Up to 10%

Reporting Requirement

:

Numerator/Denominator

Advancing Care Information Objective

:

Patient-specific Education

Advancing Care Information Measure

:

Not Required

Required/Not Required for Base Score

:

Up to 10%

Performance Score

:

Numerator/Denominator

Advancing Care Information Objective

:

Coordination of Care through Patient Engagement

Advancing Care Information Measure

:

View, Download, or Transmit (VDT)

Required/Not Required for Base Score

:

Not Required

Performance Score

:

Up to 10%

Reporting Requirement

:

Numerator/Denominator

Advancing Care Information Objective

:

Secure Messaging

Advancing Care Information Measure

:

Not Required

Required/Not Required for Base Score

:

Up to 10%

Performance Score

:

Numerator/Denominator

Advancing Care Information Objective

:

Patient-Generated Health Data

Advancing Care Information Measure

:

Not Required

Required/Not Required for Base Score

:

Up to 10%

Performance Score

:

Numerator/Denominator

Advancing Care Information Objective

:

Health Information Exchange

Advancing Care Information Measure

:

Send a Summary of Care

Required/Not Required for Base Score

:

Required

Performance Score

:

Up to 10%

Reporting Requirement

:

Numerator/Denominator

Advancing Care Information Objective

:

Request/Accept Summary of Care

Advancing Care Information Measure

:

Required

Required/Not Required for Base Score

:

Up to 10%

Performance Score

:

Numerator/Denominator

Advancing Care Information Objective

:

Clinical Information Reconciliation

Advancing Care Information Measure

:

Not Required

Required/Not Required for Base Score

:

Up to 10%

Performance Score

:

Numerator/Denominator

Advancing Care Information Objective

:

Public Health and Clinical Data Registry Reporting

Advancing Care Information Measure

:

Immunization Registry Reporting

Required/Not Required for Base Score

:

Not Required

Performance Score

:

0 or 10%

Reporting Requirement

:

Yes/No Statement

Advancing Care Information Objective

:

Syndromic Surveillance Reporting

Advancing Care Information Measure

:

Not Required

Required/Not Required for Base Score

:

Bonus

Performance Score

:

Yes/No Statement

Advancing Care Information Objective

:

Electronic Case Reporting

Advancing Care Information Measure

:

Not Required

Required/Not Required for Base Score

:

Bonus

Performance Score

:

Yes/No Statement

Advancing Care Information Objective

:

Public Health Registry Reporting

Advancing Care Information Measure

:

Not Required

Required/Not Required for Base Score

:

Bonus

Performance Score

:

Yes/No Statement

Advancing Care Information Objective

:

Clinical Data Registry Reporting

Advancing Care Information Measure

:

Not Required

Required/Not Required for Base Score

:

Bonus

Performance Score

:

Yes/No Statement

Can I participate in MIPS without an EHR?

Clinicians without an EHR can still participate in MIPS, but will not be eligible for any of the points under the ACI performance category. Use of EHR technology that is not certified will result in a zero for the category.

While still possible to participate in MIPS without an EHR, the reporting requirements will be more burdensome without the use of an EHR. The reporting mechanisms available to a practice without an EHR would be claims or qualified registry. However, use of the qualified registry option would require a manual data collection process. This would require reporting on at least 50% of the clinician’s denominator-eligible patients.

What is Pick Your Pace?+

To ease the transition to MIPS, CMS has introduced the Pick Your Pace option for the 2017 performance period. Pick Your Pace provides ECs with four options to avoid a negative payment adjustment in 2019. The options are:

  • Test—Report at least one quality measure, one improvement activity, or the required ACI measures and avoid the negative payment adjustment.
  • Partial Participation—Report at least 90 days of data for more than one quality measure, more than one improvement activity, or more than the required ACI measures and avoid the negative payment adjustment. ECs will also be eligible for a small positive payment adjustment.
  • Full Participation—Report for a full 90-day period or a full calendar year for all required quality measures, all required improvement activities, and all required ACI measures and avoid negative payment adjustments. Full participation optimizes an EC’s chance for a moderate positive payment adjustment in 2019.
  • Participate in an Advanced APM—Qualifying AAPM participants will be exempt from MIPS payment adjustments.

ECs who fail to report any data to CMS will be subject to the full negative payment adjustment of 4%.

Do I need to register for Pick Your Pace?+

No registration is required for Pick Your Pace. Groups electing to report via CMS Web Interface or administer the CAHPS for MIPS survey must register by June 30.

How will I be paid under MIPS?*

Beginning in 2019, physicians participating in MIPS will be eligible for positive or negative Medicare Part B payment adjustments that start at 4% and gradually increase to 9% in 2022. Distribution of payment adjustments will be made on a sliding scale and will be budget neutral. Payment adjustments will be based on the following:

  • Physicians with a final score at the threshold will receive a neutral payment adjustment.
  • Physicians with a final score above the threshold will receive a positive payment adjustment on each Medicare Part B claim in the payment year.
  • Physicians with a final score below the threshold will receive a negative payment adjustment on each Medicare Part B claim in the payment year.
  • Physicians with a final score in the lowest quartile will automatically be adjusted to the maximum negative adjustment on each Medicare Part B claim in the payment year.

The 2017 MACRA final rule designated 2017 a transition performance year and set the performance threshold at three points. As a result, any level of participation through the Pick Your Pace program will protect an EC from the 2019 negative payment adjustment. Since physicians in the lowest quartile will receive the maximum negative adjustment, to maintain budget neutrality, physicians with higher final scores may be eligible for a positive payment adjustment up to three times the baseline positive payment adjustment for a given year. For example, the baseline positive payment adjustment for 2019 will be 4%, so higher performers may be eligible for a positive payment adjustment of up to 12% (4% x 3).

For 2019 through 2024, an additional sliding scale for a positive payment adjustment of up to 10% will be available to “exceptional performers.” For transition year 2017, the threshold for “exceptional performers” is 70 points. This additional positive payment adjustment does not fall under the budget-neutrality requirements.

Beginning in 2026, all physicians participating in MIPS will be eligible for a 0.25% increase in their Medicare Part B physician fee schedule (PFS) payments.

How is the payment adjustment applied?+

CMS will apply the MIPS payment adjustment at the TIN/National Provider Identifier (NPI) level. ECs who reported as a group, will all receive the same final score, but the payment adjustment will be applied at the TIN/NPI level.

What if I change groups during the performance period?+

If an EC bills under more than one TIN during the performance period, CMS will use the highest final score associated with the clinician’s NPI during the performance period.

If a clinician changes TINs between the performance period and payment year, CMS will apply the final score associated with the clinician’s NPI during the performance period to the new TIN/NPI combination. For example, if a clinician practiced at TIN A during the performance period, but is practicing at TIN B during the payment year, CMS will use the final score from TIN A to apply to the payment adjustment to the new TIN B.

Are there any exemptions from MIPS?

Yes. Exemptions from MIPS include:

  • Clinicians in their first year billing Medicare;
  • Clinicians with their volume of Medicare payments or patients falling below the low-volume threshold (100 Medicare patients OR $30,000 or less in Medicare Part B charges); and
  • Clinicians who qualify for a bonus payment under AAPMs.

Are resident physicians excluded from MIPS?+

Resident physicians in their second year of Medicare billing and who are billing under their own NPI would be subject to MIPS adjustments. Resident physicians in their first year of billing would be considered new to Medicare and excluded from MIPS.

Are Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) exempt from MIPS?+

Payments for items and services made under a FQHC or RHC all-inclusive payment are exempt from MIPS. However, any Medicare Part B items and services provided and billed outside of the all-inclusive payment at FQHCs and RHCs will be subject to MIPS payment adjustments.

Is the low-volume threshold calculated at the group or individual level?+

The low-volume threshold is calculated at the participation level of the EC. If reporting as a group, the low-volume threshold would be calculated at the group level. If reporting as an individual, the low-volume threshold would be calculated at the individual level.

When will I know my low-volume threshold status?+

CMS will calculate an EC’s low-volume threshold status using two sets of claims data. For the 2017 performance period, the first data set will include claims data from September 1, 2015, to August 31, 2016. The second data set will include claims data from September 1, 2016, to August 31, 2017. CMS will not change the low-volume status of ECs who fall below the low-volume threshold during the first review period, but not the second.

What is an Alternative Payment Model (APM)?

MACRA defines any of the following as a qualifying Alternative Payment Model (APM):

  • An innovative payment model expanded under the Center for Medicare & Medicaid Innovation (CMMI), with the exception of Health Care Innovation Award recipients;
  • A Medicare Shared Savings Program (MSSP) accountable care organization (ACO);
  • Medicare Health Care Quality Demonstration Program or Medicare Acute Care Episode Demonstration Program; or
  • Another demonstration program required by federal law.

In order for a provider to receive a bonus payment through an APM, the qualified APM must also meet the following eligibility requirements:

  • Use of quality measures comparable to measures under MIPS;
  • Use of a certified electronic health record (EHR) technology; and
  • Assumes more than a “nominal financial risk” OR is a medical home expanded under the CMMI.

Which Alternative Payment Models (APMs) are eligible for the bonus?

Only AAPMs are eligible for the 5% bonus. The following APMs apply to primary care and are Advanced APMs (AAPMs) for the performance period beginning in 2017:

In order for the AAPM participant to become a qualified participant (QP) and become eligible for the 5% bonus, they must receive a set percent of payments or see a set percentage of patients through the AAPM. For the 2017 performance year, the payment threshold is 25% and the patient count threshold is 20%. QP determinations will be made at the group level. Participants who do not meet the QP thresholds may be considered a partial QP if they receive 20% of their payments or see 10% of their patients through an AAPM. Partial QPs can elect to participate in MIPS and will be scored under the APM scoring standard. For more information on the APM scoring standard, see the question below.

AAFP members can watch a concise overview of APMs, titled "MACRA: What are Alternative Payment Models (APMs)?” Watch the on-demand module now »

When will I know my QP status?+

CMS will make QP determinations three times during the performance period. QPs will be identified on the following schedule: March 31 of the performance period; June 30 of the performance period; and August 31 of the performance period. To be included in the QP calculations, an EC must be on the AAPM’s participation list during at least one of these determination snapshots. Once determined to be a QP, an EC will retain QP status for the performance period even if he or she is not included in the AAPM’s participation list during all determination snapshots. For example, an EC included on the participation list and determined to be a QP during the March 31 snapshot, but not included on the participation list during the June 30 snapshot will be considered a QP for the performance period.

How will I be paid under an APM?

If you are a QP, from 2019 through 2024, you will receive an annual 5% lump-sum bonus based on your Medicare Part B payments from the previous year’s claims. This bonus will be in addition to the incentive paid through existing contracts with the AAPM. Beginning in 2026, you will qualify for a 0.75% increase in your Medicare Part B PFS payments.

How do I know if I’m in MIPS, an AAPM, or a MIPS APM?+

Most physicians will move through MIPS until more AAPMs become available. However, family physicians interested in an AAPM model need to be prepared to start in the MIPS program. For more information on MIPS APMs, see the question below.

What is a MIPS APM?+

A MIPS APM includes APMs that did not qualify as AAPMs. All AAPMs can be MIPS APMs, but not all MIPS APMs are AAPMs. MIPS APMs do not qualify as AAPMs because they either do not meet the nominal risk criteria or the AAPM participants do not meet the payment or patient thresholds. CMS will apply an “APM scoring standard” to ECs participating in MIPS APMs. The APM scoring standard will also be applied to clinicians who did not meet QP thresholds, and are determined to be partial QPs and elect to participate in MIPS (although participation is optional). For the 2017 performance period, MIPS APMs include:

Under the APM scoring standard, ECs are subject to the MIPS reporting requirements and payment adjustments. To ease the reporting burden for the quality performance category, CMS will use the APM quality data submitted on behalf of the participating MIPS ECs. The cost performance category is scored at 0% for MIPS APM participants. CMS will assign each MIPS APM an IA score based on the APM model design and how it compares with the IAs available.

MIPs APMs will only be required to self-report the ACI performance category, as other categories are not subject to reporting requirements or CMS will draw data from other sources. The ACI performance category will require data submission by the participating APM TINs. The TIN scores will then be aggregated as a weighted average (based on the number of ECs in each TIN) to produce a single APM entity group score for the ACI performance category.

The MIPS final score will be calculated at the APM entity level and applied to each EC in the APM entity.

How does MACRA help small practices?

There is $20 million a year allocated to provide technical assistance through the QPP Small, Underserved, and Rural Support (SURS) program to practices with 15 or fewer ECs participating in MIPS. This assistance is intended to assist practices in a successful transition into the MIPS payment pathway. Priority will be given to practices in rural areas and health professional shortage areas (HPSAs).

For practices that do not qualify for the MACRA technical assistance, there is the Transforming Clinical Practice initiative (TCPi). This program was launched in September 2015 to position practices for participation in alternative payment models. Practice Transformation Networks (PTNs) are available across the country to provide coaching, resources, and tools to help practices prepare for value-based payment models. Call (800) 274-2237 or contact the AAFP to connect with a PTN near you.

What is the AAFP doing to help me?

As always, we’re committed to keeping you informed, developing resources to support your quality improvement efforts, and helping you provide cost-effective care. As information, tools, and resources to help you comply with and benefit from MACRA become available, we will update AAFP.org and spread the word through  AAFP News and Family Practice Management (FPM).

We will continue to advocate vigorously for the following:

  • Improved payment for primary care;
  • Administrative simplification, including reducing prior authorizations;
  • Harmonization of measures across all private and public payers through the use of the Core Quality Measure Collaborative Core Measures Set; and
  • Reasonable reporting requirements

What can I do now to prepare for MACRA implementation?*

While the first year for payment adjustments under MACRA is 2019, performance in 2017 will determine those payments. Clinicians can prepare for 2017 by choosing and working towards the requirements for one of the Pick Your Pace options. Clinicians and practices should assess which option best suits their current capabilities. Measures(qpp.cms.gov) and improvement activities(qpp.cms.gov) are available for review on the CMS Quality Payment Program website. Whether it’s selecting the test option or the full participation option, it is vital for clinicians to engage with the Quality Payment Program in some fashion to avoid a negative payment adjustment in 2019.  

If you submitted quality data during the last calendar year, you should access your Quality and Resource Use Report (QRUR). This report will help you understand your performance in terms of cost and quality so you can prioritize potential areas for improvement. The AAFP has created a MACRA Readiness Assessment to walk you through steps you can take to prepare for MIPS.

If your practice doesn’t provide chronic care management (CCM) services, consider the cost-benefit opportunity of increasing revenue to support needed practice transformation or quality improvement projects. Medicare began paying for CCM codes on January 1, 2015.
CCM resources to help your practice start providing CCM services »
 

The AAFP also offers a comprehensive CCM Toolkit available to assist you in implementing CCM in your practice. Learn more »

Where can I find more information on MACRA?

Information, tools, and resources to help you comply with and benefit from MACRA are available from the AAFP and from FPM. We encourage you to bookmark our MACRA Ready landing page for quick access to up-to-date news and resources.

The latest news about MACRA and other payment reform topics is available from AAFP News.

How can I get answers to my practice-specific questions?

AAFP members can contact an AAFP subject matter expert or call (800) 274-2237.

Last updated: December 2016

Key:

*: Indicates a question has significantly changed since the last update.

+: Indicates a new question added to the FAQ.

Key:

*Indicates a question has significantly changed since the last update.

+Indicates a new question added to the FAQ.

Key:

*: Indicates a question has significantly changed since the last update.

+: Indicates a new question added to the FAQ.