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Value-Based Modifier Program Timeline Reminder


Value-Based Modifier Program Timeline Reminder

Date Posted: Tuesday, March 10, 2015

 

The Social Security Act requires that CMS establish a Value Modifier that provides for differential payment under the Medicare Physician Fee Schedule (MPFS) based upon the quality of care furnished compared to cost during a performance period. By law, the Value Modifier is to be applied to:

* Specific physicians and groups of physicians that CMS determines appropriate starting January 1, 2015; and

* All physicians and groups of physicians by January 1, 2017.

Accordingly, CMS established the Physician Feedback/Value-Based Payment Modifier Program to provide comparative performance information to individual physicians and groups, as part of Medicare's efforts to improve the quality and efficiency of medical care.

The program (which is specific to Fee-For-Service Medicare-not Medicare Advantage) contains two primary components:

* The Physician Quality and Resource Use Reports (QRURs), and

* The Value-Based Incentive Payment Modifier (Value Modifier).

Beginning January 1, 2015, the Centers for Medicare & Medicaid Services (CMS) began applying a Value-Based Payment Modifier (Value Modifier) to physician payments under the Medicare Physician Fee Schedule for physicians in groups with 100 or more Eligible Professionals (EPs).

EPs consist of physicians, practitioners, physical or occupational therapists, qualified speech-language pathologists, and qualified audiologists. A group is defined by its Medicare-enrolled Taxpayer Identification Number (TIN).

Timeline Reminder:

The Value Modifier Program is being gradually phased in as follows:

* In 2015, the payment adjustments will apply to physicians in groups of 100 or more Eligible Professionals (EPs), based on a 2013 performance period.

* In 2016, the payment adjustments will apply to physicians in groups of 10 or more EPs based on 2014 performance;

* In 2017, the payment adjustments will apply to physician solo practitioners and physicians in groups of 2 or more EPs based on 2015 performance; and

* Beginning 2018, the payment adjustments will also apply to non-physician EPs who are solo practitioners or are in groups of 2 or more EPs. Please note that the performance period for the Value Modifier that will be applied in 2018 will be proposed and finalized in the CY 2016 Medicare Physician Fee Schedule proposed and final rules, respectively

Source: American Institute of Healthcare Compliance (AIHC)


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