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MACRA is here – and what you don’t know can hurt you!

May 18, 2017

If you participate in Medicare Part B and if you don’t take action before October 2nd you will receive a 4% negative payment adjustment in 2019.

What is MACRA?

The Medicare Access and CHIP Reauthorization Act (MACRA) repealed the Sustainable Growth Rate methodology used to update physician fee schedule reimbursement and replaced it with a new reimbursement model, the Quality Payment Program (QPP).  Through MACRA physicians will fall into one of two tracks:

  • Merit-based Incentive Payment System (MIPS) – most providers will participate in this track
  • Advanced Alternative Payment Model (APM) - providers in this track are required to be part of a risk-based payment model

Does it impact me?

Probably.  Any services billed under the Medicare Physician Fee Schedule (MPFS) will be impacted.  Clinicians affected include:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists

Clinicians with $30,000 or less in Medicare charges OR fewer than 100 Medicare patients are exempt from the QPP.

When will this affect me?

  • Now!  January 1, 2017 through December 31, 2017 is the first performance period. 
  • October 2, 2017 – Last day to begin collecting your performance data in order to not receive a negative payment adjustment
  • March 31, 2018 -  Deadline to submit performance data

How can I participate?

There are 4 choices for submitting performance data in 2017:

  • Do nothing – If you don’t send in any data you will receive a negative 4% adjustment in 2019.
  • Submit a minimum amount of 2017 data – Avoid a negative adjustment.
  • Submit 90 days of 2017 data – Earn a neutral or positive pay adjustment and possibly the maximum adjustment!
  • Submit a full year of 2017 data – Earn a positive payment adjustment.

MagMutual is your partner and will help you navigate MACRA in order to maximize your reimbursement adjustment.  Expect more information on what data to report and how MagMutual can help you maximize your payment to come to your inbox soon!


The information and resources provided in this course or publication have been prepared to provide general information only. It is not to be relied upon in lieu of or as a substitute for legal, medical or other professional advice. The laws, rules, regulations and case law may differ in your state. Please consult a licensed attorney in your state for specific questions and advice. While all care has been taken in the preparation of this course or publication, no responsibility is accepted by MagMutual Insurance Company or the MagMutual Patient Safety Institute or its employees or agents for any errors, omissions, or inaccuracies, or for any known or unknown consequences that may result from reliance on any information provided in this publication.