MACRA (Medicare Access and CHIP Reauthorization Act) establishes “value-based” payment models. Importantly, MACRA changes neither the importance of the physician service codes as defined in the AMA’s CPT Manual nor the relevance of the RVUs assigned to each service in Medicare’s annual physician fee schedule (PFS). There are two payment options within MACRA: (1) Alternative Payment Models (AMPs), which require high levels of cross specialty collaboration and risk sharing and (2) the Merit-based Incentive Payment System (MIPS). Nearly all physicians will be part of the MIPS. Within this “system,” Medicare payments will be adjusted upward or downward based on the composite performance score (CPS). CPS has 4 components: quality, resource use, clinical practice improvement, and meaningful use of certified EHR technology. Your CPS will be calculated based on information collected by Medicare and information that you submit or is submitted on your behalf. Optimization with MACRA is achievable with planning and EHR tools that improve patient care.  

Learning Objectives

  • Discuss the effect of MACRA on the role of Medicare’s physician fee schedule.
  • Optimize use of the existing high-value primary care codes, IPPE, the AWVs, and the TCMs and review future roles of the CCM codes.
  • Generate clean and detailed reports based on claims and data.  

Faculty Disclosures

The following financial relationships have been disclosed by faculty.

John D. Goodson, MD, FACP

No relevant financial relationships. 

Commercial Supporter

Not Applicable

Education Partner

Not Applicable

Fine Print

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