MACRA Quality Payment Program Guide

The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) is a Quality Payment Program that will affect how clinicians are reimbursed for Part B Medicare claims, starting in 2019.

Most clinicians will fall under the Merit-based Incentive Payment System (MIPS), and earn a payment adjustment, positive or negative, based on evidence-based and practice specialty quality data.

Payments will be impacted in 2019, based on 2017 performance, starting at 4% and increasing yearly.

Data must be collected in 2017 on chosen performance measures and submitted to the Centers for Medicare & Medicaid Services (CMS) to avoid a 4% penalty.

How Adjustments Will Be Determined

The MACRA Quality Payment Program is budget neutral for Medicare dollars, meaning eligible clinicians are competing to be top performers. Data submitted each year will be analyzed and a composite score will be calculated. Based on the composite score, clinicians above average will earn a positive adjustment and those below will receive a penalty, up to the maximum adjustment assigned for that year.

While employed professionals may have some protection in their salary contract initially, formulas for compensation are expected to change from heavy reliance on Relative Value Units (RVU) to quality-based factors.

Who is Affected

  • Medical Doctors
  • Doctors of Osteopathy
  • Doctors of Podiatric Medicine
  • Doctors of Dental Surgery/Medicine
  • Doctors of Optometry
  • Chiropractors
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists
  • Physician Assistants

In 2019, Medicare has proposed to add more clinical professions such as physical therapists, clinical social workers and more.

Engage for Bonuses

Clinicians strategically prepared for MIPS and achieving exceptional results will be rewarded with an additional bonus in addition to their positive payment adjustment.


The Anders Health Care Services Team is prepared to assist your health care organization in transitioning into the first year of the program. To learn more about Anders Health Care Services or arrange a meeting with our team, please contact:
Senior Health Care Consultant Julie K. Aman, CMPE, CRCE-I, 618-477-1015, jaman@anderscpa.com