MACRA is a bipartisan legislation enacted to reform Medicare payments for physician services. It aims to transition Medicare from a fee-for-service model to a value-based payment system.
MIPS is a payment system established by MACRA that consolidates the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) incentive program. MIPS adjusts Medicare payments based on performance across quality, cost, improvement activities, and promoting interoperability categories.
APMs are payment approaches that provide incentives to improve the quality and cost of healthcare. MACRA encourages clinicians to participate in APMs by offering financial incentives and exempting them from MIPS reporting requirements.
QPP is the framework established by MACRA that includes MIPS and APMs. It provides eligible clinicians with two tracks for participation: MIPS or Advanced APMs.
CPS is a score calculated under MIPS that evaluates a clinician’s performance across four categories: quality, cost, improvement activities, and promoting interoperability. It determines the payment adjustment applied to Medicare Part B payments.
Advanced APMs are a subset of APMs that meet specific criteria outlined by MACRA. Clinicians participating in Advanced APMs are eligible for additional incentives and are exempt from MIPS reporting requirements.
Quality measures are standardized metrics used to assess the quality of care provided by clinicians. MACRA requires clinicians participating in MIPS to report data on various quality measures to determine their performance scores.
Improvement activities are tasks that aim to enhance patient care and clinical practice. Clinicians participating in MIPS must engage in improvement activities to earn points towards their performance scores.
Promoting Interoperability (formerly known as Advancing Care Information) focuses on the use of certified electronic health record (EHR) technology to improve healthcare quality, safety, and efficiency. MACRA requires eligible clinicians to meet certain requirements related to interoperability to receive full credit under MIPS.
Payment adjustments are financial incentives or penalties applied to Medicare payments based on clinician performance under MIPS. Clinicians who perform well may receive positive payment adjustments, while those who underperform may face negative adjustments.