What is MACRA?
There are many acronyms in the Medicare insurance industry. So much so, that it can be hard to keep them all straight. It is helpful to focus on the vitally important ones. MACRA is one of those acronyms that any informed agent needs to know about in order to best serve their customer base. What is MACRA stand for?
MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015. This bipartisan piece of legislation was signed into law on April 16, 2015. It created what is known as a Quality Payment Program (QPP). The Quality Payment Program is an incentive program that replaced the Sustainable Growth Rate (SGR) formula that Medicare was using. The Sustainable Growth Rate would have made payment rates for participating Medicare physicians go down significantly, which would have caused problems in the industry. Instead, the Center for Medicare and Medicaid Services (CMS) is now using the Quality Payment Program.
There are two different ways that physicians can choose to participate in the Quality Payment Program.
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The Merit-Based Incentive Payment System (MIPS). This means that physicians would be reviewed and their payment would be based on how well they perform.
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Advanced Alternative Payment Models (APMs). For physicians who choose this route, they may earn Medicare Incentive Payments by participating in an innovative payment model rather than have their rate based on their reviewed merit.
Other things that MACRA accomplished, other than implementing the Quality Payment Program and doing away with the Sustainable Growth Rate, are as follows:
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It changed the way that Medicare rewards physicians, which puts the onus on quality of service rather than volume of service.
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Under the Merit-based Incentive Payment System (MIPS), many quality programs are streamlined.
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Rewards physicians for participating in Advanced Alternative Payment Models (APMs).
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MACRA also required CMS to remove social security numbers from Medicare ID cards by 2019, in an effort to prevent identity theft and increase security for their beneficiaries.
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