4 Facts that every physician should know about MACRA

4 Facts that every physician should know about MACRA

The Merit-Based Incentive Payment System determines the Medicare payment adjustments. There are four categories which contributes to annual MIPS final score.

  • Quality (60%)

Physicians have to report on more than 6 quality for minimum 90 days including outcome measure. Groups leveraging web interface have to report 15 quality measure in one complete year.

  • Advancing Care Information or Meaningful Use (25%)

In this participants have to meet the following requirements for minimum 90 days.

  • Security Risk Analysis
  • Provide Patient Access
  • Send Care Summary
  • Analysis Security Risk
  • E- Prescribing
  • Accept/ Request Care Summary
  • Select upto 9 measures for at least 90 days to get additional credit.
  • Clinical Practice Improvement Activities (15%)

Most participants have to complete four improvement activities within minimum of 90 days.

  • Cost Based Modifier

This will be calculated from adjudicated claims and will get weighed from 2018. The final score of the providers for an year is determined by MIPS payment adjustments. The final scores are released by CMS.


In order to qualify an advanced Alternative Payment Model, participants have to use Certified EHR technology and report quality measures that are evaluated under MIPS. All the eligible providers will then qualify for the following:

  • Annual 5% bonus payment beginning from 2019 through 2024.
  • Starting from 2026, there will be higher annual premiums for few providers
  • Physician-focused payment models to increase flexibility.


Cases where physicians will not send their data,  will receive 4% negative payment adjustment in the year 2019. This penalty will increase with growing years to 5% in 2020 and 9% in 2022.


CMS has reduced the cost and time to participate with the increase in availability of Advanced APMs especially for small healthcare providers. They are even providing $20 million in one year for technical support and outreach to these small practices for atleast next five years.

To keep it precise, the payment adjustment size depends on the data submitted and quality result. With growing complexities in getting reimbursements, healthcare providers are outsourcing their medical coding and billing requirements.