Full definition
MACRA (Medicare Access and CHIP Reauthorization Act, 2015) is the US legislation that fundamentally restructured Medicare physician payment. Replaced the Sustainable Growth Rate (SGR) formula with the Quality Payment Program (QPP), which has two tracks: MIPS (for most clinicians) and Advanced Alternative Payment Models (APMs).
MACRA drives the US transition from fee-for-service toward value-based payment. Quality measures, EHR use, improvement activities, and cost — all factor into Medicare reimbursement adjustments. Advanced APM participation (qualifying ACOs, bundled-payment programmes) provides higher payment adjustments + waivers from MIPS reporting.
For clinic technology procurement in US: MACRA compliance through QPP affects platform-selection criteria. Clinics need software that supports MIPS quality measure tracking, Promoting Interoperability, FHIR-based patient access, and APM participation reporting.
Where macra (medicare access and chip reauthorization act) is used
- US Medicare physician payment
- US healthcare quality programmes
- Value-based-care contracts
- Population-health management for Medicare patients
Types of macra (medicare access and chip reauthorization act)
MIPS track
Default track — most US clinicians.
Advanced APM track
Qualifying alternative payment models — higher payment adjustments + MIPS waiver.
Quality Payment Program (QPP)
Umbrella framework encompassing MIPS + APMs.
Quantified benefits
- ▸Drives value-based-care adoption in US
- ▸Aligns Medicare payment with clinical quality
- ▸Stimulates EHR + FHIR investment
Frequently asked
How does MACRA affect my clinic?+
If you bill Medicare Part B above the low-volume threshold, MACRA via QPP affects your reimbursement. Quality measures, EHR usage, improvement activities, and cost factor into payment adjustments.
Is MACRA permanent?+
Yes — replaced the prior SGR formula permanently. Programme details continue to evolve via CMS rulemaking.
How does MOVO-X support MACRA compliance?+
MIPS quality measure tracking, Promoting Interoperability via FHIR-based patient access, Improvement Activities documentation, APM participation reporting where applicable.
What's the difference between MACRA and ACA?+
Affordable Care Act (ACA, 2010) restructured insurance markets and established many quality programmes. MACRA (2015) restructured Medicare physician payment specifically. Both contribute to US value-based-care framework.