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What is the Importance of MACRA?

Posted By Giovanna Govea

Now more than ever, there’s a growing need to limit costs in the U.S. healthcare system. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a U.S. healthcare legislation, continues to try and reduce the burden on healthcare physicians, enhance a patient’s outcome, and optimize the value of the patient care experience. The onset of 2019’s updates passed are attempting to work toward increasing efficacy and proficiency in the medical industry. Rather than improving volume through tracking the performance of a physician, a healthcare facility’s earnings become highly reliant on metrics such as these.


As MACRA allows for two new tracking systems – Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM) – healthcare physicians are able to obtain payment updates, including funding to benefactors for technical aid that’s provided to physicians. This helps provide capital for further research efforts, development, and testing of new APMs.

Medicare Incentive Payment System (MIPS)

The Merit-based Incentive Payment System (MIPS) is a law in the healthcare industry that physicians need to follow to increase their facilities reimbursement payments so that the government provides the proper amount of compensation. With the most recent changes made to legislation, there were several retired incentive programs that were brought together in the MIPS, such as:

  1. Medicare Electronic Health Record (EHR) Incentive Program
  2. Value-based Payment Modifier (VM)
  3. Physician Quality Reporting System (PQRS) Program

These incentive programs were merged to bring clarity to the administration of reporting and incentive payments. While this new change strives to relinquish any lingering obscurity, Improvement Activities has been newly added as a performance category as well to promote more accuracy with the health care payment processes.

Alternative Payment Models (APM)

Alternative Payment Models consist of a new payment system that provides awards to the participating providers for implementing medical care that’s both necessary and cost-efficient. With quality performance measured similarly to MIPS, those taking part in advanced APMs have the capability to obtain bonus payments in exchange for receiving slight risk or cost-sharing details that are patient outcome-related or satisfies other various requirements. As EHR technology (electronic health record) is required by MACRA, it’s used as a mandate for all providers that are presently taking part as well. Even though MACRA is widely-known throughout the medical industry, here are five major changes physicians and healthcare providers around the world are implementing:

  1. Centers for Medicare & Medicaid Services’ (CMS) exemptions toward extreme and uncontrollable circumstances such as natural disasters.
  2. If a medical facility satisfies certain requirements – meets the total number of patients cared for and amount of charged services – then they may potentially be exempt from MACRA reporting.
  3. CMS has raised the cost category from 0 percent in 2018 to 10 percent in 2019.
  4. The cost category weight percentage increase will overall drop the weight of the quality category itself from 50 percent to 45 percent.
  5. The removal of Social Security Numbers from all Medicare identification cards by April 2019 to increase security.

Partner With Our Professional Medical Billing Experts to Keep Your Practice On Top

Our professional medical billing specialists at ECLAT Health Solutions have received the highest quality of training and experience to correct and reduce any inaccuracies within the payment processes to ensure maximum efficiency and quality health care. As medical-industry specialists, it’s our mission to help bridge the gap between providers and payers. We stay up-to-date with the latest legislation changes, such as MACRA, to ensure your healthcare facility functions efficiently each day.


Keep your health care facility current on medicine and government regulation updates. Contact ECLAT Health Solutions and fill out our form!

Tags: Medical Billing, MACRA