KENTUCKY REGIONAL EXTENSION CENTER

The Medicare Access and CHIP Reauthorization Act (MACRA) legislation has fundamentally changed the way Medicare pays clinicians. Understanding this complex payment program and developing a successful strategy is challenging for many health care organizations, clinicians and staff in Kentucky and across the US.

The Kentucky REC offers a variety of grant funded and fee-for-service options tailored to the needs of our clients. Click on the boxes and links below or contact us to find out how we can help your organization master the Quality Payment Program.

The Basics of MACRA and the QPP

Passed in April 2015, MACRA gave the Centers for Medicare and Medicaid Services (CMS) the authority to create the Quality Payment Program or QPP. The QPP replaced the Sustainable Growth Rate (SGR) cuts with an alternative set of payment policies governing Medicare payments to eligible clinicians. The goal is to move Medicare spending increasingly toward rewarding higher quality and value and away from financial incentives for the volume of services provided.

Eligible clinicians must choose between two tracks: the Merit-Based Incentive Payment System (MIPS), or participation in an Advanced Alternative Payment Model (APM). This choice determines Medicare Physician Fee Schedule reimbursement rates and methods beginning on January 1, 2019.

MACRA Created the Quality Payment Program (QPP) with two main tracks:

1. Advanced Alternative Payment Models (APM)
2. Merit-Based Incentive Payment System (MIPS)

MACRA Quality Payment Program Timeline

*PY#: Threshold to avoid penalty & Potential Payment Adjustment

Quality Payment Program Annual Lifecycle
January 1st — December 31st