MACRA, MIPS and ACO Back Office Support

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In 2016, the final updates to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) were passed.

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You can earn up to 27% more from Medicare – or lose up to 9%.
Let CareGPS Health help you avoid negative payment adjustments in 2019.

The new MACRA law changes Medicare reimbursements starting in 2019 based on 2017 measures. The goal is to incentivize physicians to practice value-based medicine. There are two new methods of reimbursement that will determine reimbursement bonuses or penalties:

By 2022, your MIPS score will impact your Medicare reimbursement from -9% to +27%. However, working with a company like CareGPS Health that provides guidance and support meeting MACRA, you can maximize your MIPS scores with little to no out of pocket expense or added staff.

Merit-based Incentive Payment System (MIPS)


4 components of MIPS

  • Quality. This replaces the Physician Quality Reporting System (PQRS). Practices will report up to six quality measures, including at least one outcome measure, for a minimum of 90 days. You can avoid a 4% penalty on your 2019 Medicare reimbursement by reporting one Quality measure in 2017.
  • Improvement activities. In this new category. Practices will attest that they completed up to four improvement activities for a minimum of 90 days. Small practices (15 or fewer physicians) and medical groups in rural or health professionally shortaged areas only need to report one or two activities.
  • Advancing Care Information (ACI). This component replaces the EHR Meaningful Use program. Practices must fulfill the required measures—perform a security risk analysis, prescribe electronically, provide patient access to information, send a care summary, and request and accept a care summary—for a minimum of 90 days. You can also choose to submit up to nine performance measures to achieve full ACI credit. This may not apply to every practice.summary—for a minimum of 90 days. You can also choose to submit up to nine performance measures to achieve full ACI credit. This may not apply to every practice.
  • Cost. This component replaces the Value-based Modifier, but will not begin until the 2018 reporting year. No data reporting is required for this component. It will be calculated from claims.

Advanced Alternative Payment Method (AAPM)


To qualify as an APM 50% of practice must:

  1. Use a certified EHR
  2. Provide payments based on meeting quality measures
  3. Must involve financial risk sharing.

Physicians that meet these qualifying requirements are exempt from MIPS and will receive a 5% annual bonus for 6 years.

You can earn up to 27% more from Medicare – or lose up to 9%

Here is a summary of the options for participation in 2017:

  • No participation: If you don’t send in any 2017 data, then you’ll receive a negative 4% payment adjustment.
  • Submit something: If you submit a minimum amount of 2017 data to Medicare (for example, one quality measure or one improvement activity for any point in 2017), you can avoid a downward payment adjustment.
  • Submit a partial year: If you submit 90 days of 2017 data to Medicare, you may earn a neutral or positive payment adjustment and may even earn the max adjustment.
  • Submit a full year: If you submit a full year of 2017 data to Medicare, you may earn a positive payment adjustment.
  • Participate in an Advanced APM: Organizations that sufficiently participate through an Advanced APM earn a 5% Part B bonus and are exempt from MIPS.

CareGPS Health will get you MACRA ready as we :

  • Meet with your clinical team to assess your team’s performance, particularly as it relates to the Quality portion of your potential MIPS score.
  • Identify measures that reflect the clinical services your practice commonly provides.
  • Review measure selection, performance goals and whether to report as an individual or a group.
  • Identify your reporting mechanism.
  • Contact your EMR vendor to uncover the data needed.
  • Report for at least 90 days (CMS deadline: Oct. 2, 2017).
  • Complete MIPS performance (CMS deadline: Dec. 31, 2017).
  • Identify correct reporting mechanism.
  • Submit 2017 MIPS data.

Roughly two-thirds of physicians will be exempt from reporting MIPS and QPP:

  • Clinicians who enroll in Medicare for the first time in 2017
  • Clinicians who participate in an Advanced APM and are either a Qualifying APM Participant (QP) or Partial QP
  • Clinicians who bill Medicare for $30,000 or less
  • Clinicians who have provided care for 100 Medicare patients or fewer
  • Clinicians who are not in a MIPS-eligible specialty

Physicians can easily check their MIPS status by entering their National Provider Identifier into the CMS QPP portal.


The new MACRA law will once again change the reporting requirements for payment of the services provided to your Medicare patients. Here are a few facts;

  • Physicians can’t “kick the can down the road”, its play or get penalized.
  • All physicians will be compared to each in terms of the “value of care the patient received”.
  • Poor performers will be penalized financially, those dollars will provide the bonuses earned by their peers who performed at or above expectations.
  • For many practices, compliance costs can exceed the financial return on investment through incentives and avoid penalties.

Using a third-party provider like CareGPS Health should enable you the attest efficiently and with little to no out of pocket expense. Please contact us today for a free evaluation of our service. The final MACRA filing date is quickly approaching. Contact us!

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