MACRA
MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, repealed the sustainable growth rate formula and created the Quality Payment Program. It moves Medicare physician payment toward value through two tracks: MIPS and Advanced Alternative Payment Models. MACRA is the statute; MIPS and APMs are how clinicians participate.
- Enacted
- 2015 (MACRA)
- What it repealed
- The sustainable growth rate (SGR) formula
- What it created
- Quality Payment Program (QPP)
- Two tracks
- MIPS and Advanced Alternative Payment Models
What is MACRA?
MACRA is the Medicare Access and CHIP Reauthorization Act of 2015. Its headline achievement was repealing the sustainable growth rate (SGR), the formula that for years threatened steep Medicare physician pay cuts and forced Congress into repeated last-minute patches. In its place, MACRA built the Quality Payment Program to reward value rather than sheer volume.
For billers, MACRA is best understood as the legal foundation under everything the Quality Payment Program does to Part B payment.
What are the two tracks under MACRA?
The Quality Payment Program gives eligible clinicians two ways to participate:
| Track | How it works |
|---|---|
| MIPS | Composite performance score adjusts Part B payments up or down |
| Advanced APM | Risk-bearing payment models; qualifying participants are exempt from MIPS and may earn incentives |
Most clinicians land in MIPS; those in qualifying risk-bearing models follow the Advanced APM path instead.
Why does MACRA matter to medical billing?
Example: a group that ignored its Quality Payment Program obligations sees a negative MIPS adjustment quietly reduce every Medicare Part B payment two years later. Nothing on the individual remittance screams "MACRA," but the multiplier is baked in. The statute connects clinical reporting to real dollars off the fee schedule.
How should a billing team respond to MACRA?
Billing rarely owns MIPS reporting, but it feels the result, so the practical move is to connect the two. Confirm with clinical leadership whether the group is MIPS-eligible or exempt, and find out the current MIPS adjustment factor before it hits the remittance rather than after.
- Ask whether each rendering provider is a MIPS eligible clinician, opted in, or exempt (low-volume threshold).
- Model the two-year-lagged adjustment against your Part B volume so the finance team is not surprised.
- Separate the MIPS multiplier from the annual conversion factor change when explaining a year-over-year payment shift.
Treating MACRA as a line-item risk, not an abstract policy, is what keeps a negative adjustment from quietly eroding a year of Medicare revenue.
Frequently asked questions
MACRA repealed the sustainable growth rate (SGR) formula, the deeply unpopular mechanism that repeatedly threatened large across-the-board Medicare physician pay cuts and forced Congress into annual "doc fix" patches. In its place MACRA created the Quality Payment Program, shifting the payment story from volume-based cuts to value-based adjustments.
MACRA is the 2015 law; MIPS is one of the two participation tracks that law created. Saying a clinician is "in MACRA" really means they participate in the Quality Payment Program, most often through MIPS. The other track is an Advanced Alternative Payment Model, which can exempt a clinician from MIPS.
Yes. MACRA remains the governing statute for the Quality Payment Program, and CMS issues annual final rules under its authority. For 2026 the program continues with a MIPS performance threshold of 75 points. MACRA is not a temporary program; it is the permanent framework replacing the old SGR system.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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