What is MACRA/MIPS?
The MIPS program was created to improve care processes and health outcomes for patients, as well as increase the use of healthcare information and reduce the cost of care. Instead of the old fee-for-service payment model, payments are ties to quality and cost-efficient care. If you are an eligible provider who cares about the improvement in care outcomes of your patients, the Quality Payment Program is for you.
CMS has worked with providers to come up with a variety of clinical quality measures, improvement activities and objectives they believe will help providers to improve their care outcomes. Regardless of your specialty, there will be measures and activities that will apply to your practice.
Watch this video to learn more about being MACRA compliant
Is MIPS worth it?
With the negative payment adjustment being 9% in 2023, the minimum that CMS will take away for not reporting is $8,100 for eligible providers. Cost and time to report is less than half of the minimum that CMS would adjust from your base Medicare payments.
So, yes, it is worth reporting for the Merit-based Incentive Payment System (MIPS). The reporting measures are also intended to improve your quality of care, so you will have healthier, happier patients.
MACRA Payment Programs
The MACRA QPP Program helps us move more quickly toward our goal of paying for value and better care.
The Quality Payment Program has 2 paths:
Alternative Payment Models (APMs)
APMs give us new ways to pay health care providers for the care they give Medicare beneficiaries. For example:
🗹 In September 2020, CMS announced the disbursement of the 5% APM Incentive Payments to eligible physicians who were Qualifying APM Participants (QPs) based on their 2018 performance.
🗹 From 2019-2024, some participating health care providers receive a lump-sum incentive payment.
🗹 Increased transparency of physician-focused payment models.
🗹 Starting in 2026, it offers some participating health care providers higher annual payments.
Merit-Based Incentive Payment System (MIPS)
The MIPS is a program that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VBM or Value-Based Payment Modifier), and the Medicare Electronic Health Record, known incentive program, known as Meaningful Use (MU) into one single program in which Eligible Professionals (EPs) are measured on:
🗹 Resource use
🗹 Clinical practice improvement
🗹 Promoting Interoperability
How do I know if I’m eligible for MIPS?
To check eligibility for one or more clinicians, click here.
If you are an eligible provider, you will see a code(s) appear on all your Medicare Part B ERAs.
CARC 144: Positive incentive adjustment
CARC 237: Negative incentive adjustment
RARC N807: Payment adjustment based on the Merit-based Incentive Payment System
CO: This is a group code
MIPS Reporting with Microwize
🗹 MACRA/MIPS Dashboard
🗹 Unlimited support
🗹 Proactive follow ups on important MACRA/MIPS updates
🗹 Reporting to CMS (annually)
🗹 Monthly Promoting Interoperability report reviews
🗹 Template customization for MACRA/MIPS
🗹 EHR-related Clinical Improvement Activity & Quality Measure consulting
$149/month for the first provider
$99/month for each additional provider
$250 one-time setup fee per practice for registry connection
*Security Risk Assessment available for an additional fee. State Immunization Registry interface and setup, or Other Certified Clinical Registry will be billed separately (if applicable). Patient Portal and Direct Messaging are required and may require separate fees through EHR vendor.
We have the expertise and skills to help you with the tools you need for MACRA & MIPS. We have been helping physicians to be among the top providers avoiding penalties and receiving bonuses. The difference between a 9% penalty and a 9% bonus is 18%; please ignore this message if you don’t care about 18% of Medicare income.