Glossary Term

Medicare Access and CHIP Reauthorization Act

Medicare Access and CHIP Reauthorization Act‘s (MACRA) primary purpose was to transition Medicare from a purely fee-for-service model toward a reimbursement scheme that rewarded quality and efficiency from health care providers. This latter approach is known as value-based care.

MACRA introduced the Quality Payment Program (QPP). Under QPP, health care providers accepting Medicare patients have the choice between two compensation models: the Merit-based Incentive Payment System (MIPS) track or the Advanced Alternative Payment Model (AAPM). While both programs seek to incentivize quality and efficiency in medical care, the AAPM track had the potential for greater compensation but comes with a higher risk for financial loss than is the case under MIPS. 

MIPS is the default reimbursement model for a Medicare health care provider unless the provider qualifies for potential participation within the AAPM. Most health care providers serving Medicare patients enroll in the MIPS compensation model.

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