Medicare Value-Based Payment Modifier for 2017

August 3, 2015
There are currently three Medicare quality reporting programs with different criteria, timelines and penalties. They are:

1) EHR (Meaningful Use) Incentive Program
2) PQRS
3) Value-Based Payment Modifier - Applies to all Part B physicians in 2017, based on performance in 2015. Possible increase or decrease Medicare payments based on cost and quality scores. Penalties can be as high as 4% in 2017.

The following summary information regarding the Value-Based Payment Modifier is from CMS. Click on the link below for additional information.

"The Value Modifier provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS) based upon the quality of care furnished compared to the cost of care during a performance period. The Value Modifier is an adjustment made on a per claim basis to Medicare payments for items and services under the Medicare PFS. It is applied at the Taxpayer Identification Number (TIN) level to physicians (and beginning in 2018, to non-physician EPs) billing under the TIN.

The Affordable Care Act requires CMS to apply the Value Modifier to all physicians and groups of physicians starting in 2017.  

 

In 2017, Medicare will apply the Value Modifier to physician payments under the Medicare PFS for physician solo practitioners and physicians in groups of 2 or more EPs. This policy completes the phase-in of the Value Modifier to all physicians and groups of physicians as required by the statute. CY 2015 is the performance period for the Value Modifier that will be applied in CY 2017.

 

In order to be eligible for upward, downward, or neutral payment adjustments under the Value Modifier quality-tiering methodology and to avoid an automatic negative two percent (“-2.0%”) (for physician groups with between 2 to 9 EPs and physician solo practitioners) or negative four percent ("-4.0%") (for physician groups with 10 or more EPs) Value Modifier payment adjustment in CY 2017, EPs in groups and solo practitioners MUST participate in the PQRS and satisfy reporting requirements as a group or as individuals in CY 2015. 

 

Physician groups with 2 or more EPs can avoid the automatic “-2.0%” (for groups with between 2 to 9 EPs) or "-4.0%" (for groups with 10 or more EPs) Value Modifier payment adjustment in CY 2017 by participating in the PQRS GPRO in CY 2015 and meeting the satisfactory reporting criteria to avoid the “-2.0%” CY 2017 PQRS payment adjustment. Alternatively, physician groups with 2 or more EPs can avoid the automatic “-2.0%” (for groups with between 2 to 9 EPs) or "-4.0%" (for groups with 10 or more EPs) Value Modifier payment adjustment in CY 2017, if the EPs in the group participate in the PQRS as individuals in CY 2015 and at least 50% of the EPs in the group meet the satisfactory reporting criteria as individuals (or in lieu of satisfactory reporting, satisfactorily participate in a Qualified Clinical Data Registry) to avoid the “-2.0%” CY 2017 PQRS payment adjustment. Physician solo practitioners can avoid the automatic “-2.0%” Value Modifier payment adjustment in CY 2017, if the solo practitioner participates in the PQRS as an individual in CY 2015 and meets the satisfactory reporting criteria as an individual (or in lieu of satisfactory reporting, satisfactorily participate in a Qualified Clinical Data Registry) to avoid the “-2.0%” CY 2017 PQRS payment adjustment."

 

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/valuebasedpaymentmodifier.html#What%20is%20the%20Value-Based%20Payment%20Modifier%20%28Value%20Modifier%29

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