Defining MACRA and Answering FAQs

Posted in Defining MACRA

MACRA comprises more than 2,400 pages of regulations, which means clinicians need to interpret numerous reports and understand the implications of these regulations on their organizations. MACRA places tremendous reporting demands on health systems and clinicians. Clinicians must also choose which measures they’ll go at risk for—an added strategic decision-making demand on top of the reporting demands. MACRA’s first performance year is 2017, with changes expected every year, so health systems need to start preparing for MACRA now. Considering how complex MACRA is with over 2,400 pages of instructions needed to be followed it’s no surprise that a lot of doctors, clinicians, and health organizations have a hard time Defining MACRA.


MACRA has such a ton of requirements that clinicians and doctors have to prepare to meet the requirements. Below are the steps they have to take in order to prepare for MACRA Requirements


  • Know your Status and keep track of it: The American Medical Association has a payment model evaluator that helps you know if you are qualified for or exempt from MIPS or Advanced AM tracks. You can also keep track of all MIPS and MACRA requirements to maximize your Medicare bonuses over time. These requirements will likely be updated on an annual basis so keeping track can help you meet and even surpass all requirements.


  • Meet current quality reporting program measures: The sooner you start meeting the existing program measures successfully, the better prepared you’ll be to earn a higher payment bonus once MIPS starts. MIPS will combine and then streamline existing incentive programs and performance determined payment into one. So if you already have these existing rules met, you’ll be off to a good start.


  • Target specific improvement areas: With this new reporting system, health organizations and practitioners might have to report on areas they don’t normally report on. Targeting specific areas to report on will help health organizations be proactive in gathering data in anticipation. This will make things easier and flow more smoothly.


  • Prepare for CPIA: The center for Medicare and Medicaid is yet to release the specific requirements for certain categories such as clinical practice improvement activities but they will definitely consist of improving them so the more prepared health practitioners and organizations are the better.

And if there are any questions on how to meet these requirements, (and there most likely will be) below are answers to some frequently asked questions.

Who is required to participate?

MACRA is not just for Physicians. It’s also required for Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, and groups that include clinicians who bill under Part B. Individuals who bill Medicare more than $30,000 and anyone already part of an Advanced APM will also participate.

What if I don’t report at all?

Those who don’t report will not only have to pay the 4% fine but also face potential impact on their reimbursement, future job search efforts and lost reputation with potential patients.

If I work in a large organization, do I need to worry about preparing for MACRA?


Should I report as an individual or group?

MACRA defines a group as a single Taxpayer Identification Number (TIN) with two or more MIPS eligible clinicians, as identified by their individual National Provider Identifier (NPI), who have reassigned their Medicare billing rights to the TIN. If you don’t fit this requirement then you should report as an individual.

What about multi-specialty practices, should they report as a group?

Most practices find it beneficial to report as a group as reporting individually will be a tedious process. Reporting as a group makes it relatively easier to achieve measures, such as care coordination, that requires effective communication among providers, patients, and specialists. Everybody can participate in this.