The Medicare Access and CHIP Reauthorization Act (MACRA) is off the ground, with practices nationwide setting implementation target dates that are right around the corner.  For locum physicians, an understanding of the system will give you a leg up when working in practices with Medicare patients.  We’ve got the key points for you here.


The good news is that MACRA aims to simplify repayment with the new Merit Based Incentive Payments System (MIPS). It repeals the sustainable growth rate (SGR) methodology for determining updates to the Medicare physician fee schedule.  Practices will need to choose between the new MIPS set-up or an annual positive or flat fee update called the Alternative Payment Model (APM).

Impact and Exemptions:

  • MACRA does not affect providers who do not bill for Medicare or pediatricians.
  • Some hospitals and facilities will be exempt, except requirements to their technology and computerized communication systems.
  • Physicians new to Medicare and with certain other caps (less than $10,000 in Medicare charges, 100 or fewer Medicare patients, etc.) will be exempt.
  • Eligible “providers” will now be eligible “clinicians” and include some additional practitioners such as chiropractors, dentists, nurse practitioners, and physician assistants.

MIPS Versus APM:

The goal of the MIPS (merit-based incentive payment system) is to move to a value-based pay system over one that values sheer volume.  To that end, eligible clinicians will receive a score, the composite performance score (CPS) which will determine reimbursement.

The APM (Alternative Payment Model), on the other hand, has the stated goal of increasing the quality of patient care, thereby improving patient outcomes, through various multi-payer options (such as participant groups assuming a certain amount of financial risk themselves).

Both programs are moving to electronic health record (EHR) technology to document and communicate care, but APM specifically requires 50% participation in EHR the first year (which increases to 75% the second year).

Regardless of participation, the EHR will undoubtedly become the standard in computerized healthcare facilitation.

Some Key Dates for MACRA:

  • January 2017: healthcare organizations will start using at least the 2014 Edition Certified EHR. Also, eligible clinicians will start attesting to support of information exchange to the Office of the National Coordinator of Health IT (ONC).
  • Within the first year: healthcare organizations wishing to be exempt from MIPS will set up the APM system.
  • By 2018: The 2015 Edition Certified EHR will be required.
  • By 2019: The former Physician Quality Reporting System (PQRS) will be fully resolved, with all adjustments rolled under MACRA. Also by 2019, practices which failed to implement the new system will start to be penalized.
  • 2019-2024: 5% lump-sum bonuses expected for many providers
  • 2026: The date when all transition should be complete

Want to Learn More?

While administrative personnel are primarily responsible for billing, an understanding of MACRA may help you within the system.  While the hefty, nearly 1,000 page document might not make for the best bedtime reading, you can learn all you wish to know on the Centers for Medicare & Medicaid Services site: