Overview
The Medicare Access and CHIP Reauthorization Act of 2015, universally known as MACRA, is the federal law that rewrote Medicare physician payment policy. MACRA accomplished two things structurally: first, it permanently repealed the Sustainable Growth Rate (SGR) formula that had produced annual threatened Medicare physician fee cuts for over a decade; second, it established the Quality Payment Program (QPP) which links a portion of Medicare Part B professional payment to performance on quality and efficiency metrics.
Under the QPP, MACRA creates two payment paths for eligible clinicians: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (Advanced APM) track. MIPS is the default. Clinicians who participate sufficiently in qualifying Advanced APMs — MSSP ACO Enhanced, REACH, certain CPC+ arrangements, and others — are removed from MIPS and instead receive a 5% APM incentive payment annually (through the 2024 performance year; the incentive structure evolves thereafter). The policy intent is to push provider participation toward risk-bearing APMs as the mature state of Medicare payment.
For revenue cycle, MACRA's operational footprint is substantial. Every Medicare Part B claim is subject to a MIPS-driven payment adjustment two years after the performance year. Attribution for MIPS and APM scoring is claims-driven. Quality measure data flow is a hybrid of claims-based and EHR-submitted reporting. Contracts and network participation decisions have MACRA implications because participating in certain Advanced APMs changes the MIPS reporting posture of the entire TIN.
MACRA also contained other meaningful provisions: a long-term extension of the Children's Health Insurance Program (CHIP), policy changes to Medicare Advantage, and modifications to physician payment updates that continue to unfold. From an RCM perspective, however, the dominant lasting effect is the QPP and its MIPS/APM scoring machinery. Operationally, most health-system revenue cycle teams maintain a QPP coordination function that spans clinical documentation, EHR, coding, and finance because MIPS performance shapes real dollars at stake starting two years after each performance year.
Strategically, MACRA codified the federal policy direction from volume-based to value-based payment. Subsequent regulations — from CMS's MVP framework to the evolving Advanced APM qualifying rules — all derive from the MACRA statutory architecture, and understanding how MACRA's components interlock is essential for any organization negotiating payer contracts or planning multi-year revenue strategies.
Compliance programs treat Medicare Access and CHIP Reauthorization Act as a recurring audit trigger rather than a one-time policy exercise. The practical approach is a quarterly Medicare Access and CHIP Reauthorization Act self-audit tied into the broader compliance calendar, with findings tracked against mips program and value based care so a Medicare Access and CHIP Reauthorization Act gap cannot silently persist from one audit cycle to the next. Reviewers on this site pair every Medicare Access and CHIP Reauthorization Act reference with the corresponding regulatory citation so the policy owner can trace the requirement back to its authoritative source.
Industry benchmark
MACRA (Pub. L. 114-10); CMS Quality Payment Program final rules annually. MIPS/APM participation data is published by CMS in annual QPP Experience Reports.
Worked example
A 75-provider multispecialty group in Ohio has 62 MIPS-eligible clinicians reporting as a group under MACRA's QPP. 13 clinicians participate in an Advanced APM (MSSP ACO Enhanced track) and are Qualifying APM Participants, excluded from MIPS and receiving the 5% APM bonus on their Medicare Part B billings for the payment year. The remaining 49 clinicians are scored under MIPS, with adjustments applied to their Medicare Part B professional payments two years post-performance.
Frequently asked questions — Medicare Access and CHIP Reauthorization Act
When did MACRA take effect?
MACRA was enacted April 16, 2015. The Quality Payment Program's first performance year was 2017, with the first payment adjustments applied in 2019. The program has been refined annually through CMS rulemaking since.
Did MACRA eliminate the SGR?
Yes. The SGR formula, which had been patched by Congress for years, was permanently repealed by MACRA. Physician fee schedule updates since 2015 have been governed by new, largely small fixed-percentage update factors rather than SGR's formulaic approach.
Is the Advanced APM track better than MIPS?
It depends. The 5% APM bonus is predictable and avoids MIPS reporting administrative burden, but qualifying for Advanced APM requires sufficient participation in risk-bearing arrangements. Organizations not yet ready for two-sided risk typically remain in MIPS.
Are CHIP or Medicare Advantage affected by MACRA?
Yes. MACRA extended CHIP funding through 2019 (subsequent reauthorizations have followed) and introduced several Medicare Advantage provisions, though the MIPS/APM quality-payment provisions are the dominant operational legacy for provider organizations.
Disclaimer
This glossary entry is operational reference for revenue-cycle and medical-billing professionals. It is not legal, clinical, or contractual advice. Industry benchmarks cite named public sources where available; always verify against the current guidance from the authority body before relying on a number in a contract, policy, or compliance filing.