CMS is hosting a call on November 1, 2016 to discuss how physicians and other providers can report quality measures during 2016 to maximize participation in Medicare quality programs, including the Physician Quality Reporting System (PQRS), Medicare Electronic Health Record (EHR) Incentive Program, Value-Based Payment Modifier (Value Modifier), and the Medicare Shared Savings Program.
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CMS Call: 2016 Medicare Physician Quality Reporting Programs (Dec. 8)
On December 8, 2015, CMS is hosting a call to discuss how the 2016 Medicare Physician Fee Schedule final rule impacts Medicare quality reporting programs. Specifically, the call will address changes to the Physician Quality Reporting System, the Electronic Health Record Incentive Program, the Comprehensive Primary Care initiative, the Value-Based Payment Modifier, the Medicare Shared…
CMS Finalizes Medicare Physician Fee Schedule Rates, Policies for 2016
Today the Centers for Medicare & Medicaid Services (CMS) published the final rule to update the Medicare physician fee schedule (MPFS) for calendar year (CY) 2016. Despite the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) establishing a 0.5% conversion factor (CF) update for 2016, the final 2016 CF of $35.8279 actually is a decrease compared to the 2015 CF of $35.9335. This is because CMS has more than offset the 0.5% MACRA update with a -0.02% budget neutrality adjustment in addition to a -0.77% “target recapture amount” to reach a statutory target for savings achieved from misvalued code adjustments (discussed below). Final rates and policies are effective January 1, 2016, with certain exceptions. CMS is accepting comments until December 29, 2015 on a limited number of provisions of the rule (e.g., interim final work, practice expense, and malpractice RVUs; interim final new, revised, potentially misvalued HCPCS codes; and changes to the physician self-referral list of codes). The sweeping rule includes numerous policy provisions, including the following:
Continue Reading CMS Finalizes Medicare Physician Fee Schedule Rates, Policies for 2016
CMS Schedules Provider Calls on Medicare Quality Programs
CMS is hosting several calls and webcasts in September and October 2015 on various Medicare quality programs, including the following:
- A September 17 webcast/call will focus on the 2014 Annual Quality and Resource Use Reports (QRURs) that the agency is making available to group practices and solo practitioners nationwide. CMS will hold a separate call
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CMS Posts Initial Results for Physician Value-based Payment Modifier
Under the ACA, the Physician Value-Based Modifier (Value Modifier) policy rewards physicians and groups of physicians who provide high quality and cost effective care, while penalizing those who did not meet objectives. Physicians in group practices of 100 or more eligible professionals who submit claims to Medicare under a single tax identification number are subject…
CMS Call on Physician Quality Reporting Programs (March 18)
On March 18, 2015, CMS is hosting a call to discuss how providers may report once across various 2015 Medicare Quality Reporting Programs, including the Physician Quality Reporting System (PQRS), the Medicare Electronic Health Record (EHR) Incentive Program, the Value-Based Modifier (VM) program, and the Medicare Shared Savings Program. Providers that satisfactorily report will avoid…
HHS Sets Ambitious Goals for Medicare Quality/Value-Based Purchasing, Alternative Payment Models
Today HHS Secretary Sylvia M. Burwell announced ambitious plans to move from “volume to value in Medicare payments” by accelerating the share of Medicare fee-for-service (FFS) payments that are tied to quality and value and reimbursed through alternative payment models. The first goal in the initiative is for 30% of Medicare provider payments to be…
CMS Publishes Final 2015 Medicare Physician Fee Schedule Rule for 2015
On November 12, 2014, CMS published its final rule to update the Medicare physician fee schedule (MPFS) for CY 2015. Highlights of the sweeping rule include the following:
- The Protecting Access to Medicare Act (PAMA) of 2014 provides for a 0% update to the conversion factor (CF) for MPFS services furnished between January 1, 2015 and March 31, 2015, with the CF adjusted afterwards according to the statutory Sustainable Growth Rate (SGR) formula. In the final rule, CMS determined that based on the zero percent update under PAMA and adjustments necessary to maintain budget neutrality, the CF for the first quarter of 2015 will be $35.8013 (compared to $35.8228 in 2014). CMS also announced that the CF for April 1, 2015 through December 31, 2015 will be $28.2239 – a 21.2% reduction — unless Congress establishes an alternative CF or otherwise modifies the SGR formula. While there is an expectation that Congress eventually will override this payment cut, the form any such action might take is speculative at this point.
Continue Reading CMS Publishes Final 2015 Medicare Physician Fee Schedule Rule for 2015
CMS Call on Changes to Physician Quality Reporting Programs for 2015 (Dec. 2)
On December 2, 2014, CMS is hosting a provider call to discuss changes to the Medicare physician quality reporting programs in the 2015 Medicare Physician Fee Schedule final rule. Among other things, the call will cover changes impacting the Physician Quality Reporting System (PQRS), Value-based Payment Modifier, Physician Compare, Electronic Health Record (EHR) Incentive Program,…
CMS Call on 2013 Physician Quality and Resource Use Reports (Oct. 23)
On October 23, 2014, CMS is hosting a call on 2013 Quality and Resource Use Reports (QRURs) for physician group practices and physician solo practitioners. The 2013 QRURs contain quality and cost performance data that will be used in determining the applicable Value-Based Payment Modifier for 2015.
CMS Call: How to Avoid 2016 Negative Payment Adjustments under Medicare Quality Reporting Programs
On September 17, 2014, CMS is hosting a call on negative payment adjustments that could apply under several Medicare quality reporting programs in 2016. Specifically, the call will offer instructions on how eligible professionals and group practices can avoid the 2016 Physician Quality Reporting System negative payment adjustment, satisfy the clinical quality measure component of…
CMS Publishes Proposed MPFS Rule for 2015
On July 11, 2014, CMS published its proposed rule to update the Medicare physician fee schedule for CY 2015. The proposed rule reflects enactment of the Protecting Access to Medicare Act (PAMA) of 2014, which provides for a 0% update to the conversion factor (CF) for MPFS services furnished between January 1, 2015 and March 31, 2015. In the Proposed Rule, CMS estimates that with the application of a budget neutrality adjustment, the CF for the first quarter of 2015 would be $35.7977 (compared to $35.8228 in 2014). Under PAMA, the CF will be adjusted on April 1, 2015 according to the Sustainable Growth Rate (SGR) formula unless Congress takes additional legislative action. CMS does not speculate on the CF that will be applicable April 1, 2015 through December 31, 2015, but CMS previously estimated that the SGR would result in about a 20.9% cut in MPFS payments for 2015 if Congress does not again intervene. There is an expectation that Congress eventually will override this payment cut, but the timing and extent of any such relief cannot be assured at this time. Other key provision in the proposed rule include the following:Continue Reading CMS Publishes Proposed MPFS Rule for 2015
CMS Issues Call for PQRS Quality Measures
On May 1, 2014, CMS will begin accepting recommendations for potential Physician Quality Reporting System (PQRS) quality measures for 2016 and future rulemaking years. Quality measure proposals also will be considered for use in other physician quality programs, including the Value Based Modifier, Physician Compare, and the Medicare Shared Savings Program.
CMS Call Regarding the Medicare Physician Value-Based Payment Modifier (Dec. 3).
On December 3, 2013, CMS will host a National Provider Call to provide an overview of the value-based payment modifier (VM) under the final 2014 Medicare Physician Fee Schedule final rule (which has not yet been released). CMS will also describe how the VM is aligned with the reporting requirements under the Physician Quality Reporting…
CMS Call on 2015 Value-Based Payment Modifier (Sept. 24)
On September 24, 2013, CMS will host a call for providers on “Program Year 2012 Quality and Resource Use Report – Mapping a Route to Success for the 2015 Value-Based Payment Modifier.” The call will focus on the 2012 Quality Resource Use Reports (QRURs), which illustrate how a group would be impacted by the final…
CMS Proposes Updates to Medicare Physician Fee Schedule, Other Part B Policies for CY 2014
On July 19, 2013, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule updating Medicare physician fee schedule (PFS) rates and polices for calendar year (CY) 2014. CMS projects that PFS payments will be reduced by approximately 24.4% in 2014, largely due to the statutory Sustainable Growth Rate (SGR) update formula (although Congress is expected to eventually take action to block the automatic cuts, as it has in the past). The rule also includes a number of significant policy proposals, including the following highlights:Continue Reading CMS Proposes Updates to Medicare Physician Fee Schedule, Other Part B Policies for CY 2014
CMS Call: PQRS Reporting and the Value-based Payment Modifier (July 25)
On July 25, 2013, CMS is hosting a provider call on “CMS Proposals for Physician Quality Reporting System (PQRS) and Physician Value-Based Payment Modifier under the Medicare Physician Fee Schedule 2014 Proposed Rule.”
CMS Call on PQRS Reporting and the Value-based Payment Modifier (July 31)
On July 31, 2013, CMS is hosting a National Provider Call entitled “Choosing Your Physician Quality Reporting System (PQRS) Group Reporting Mechanism and Implications for the Value-based Payment Modifier.” The target audience for the call is physicians and physician group practices, practice managers, medical and specialty societies, and payers/insurers.
GAO Offers Recommendations for Medicare Physician Value Modifier Program
The GAO has examined how private-sector efforts to adjust physician payments to reflect quality and efficiency could be applied successfully to the Medicare program. As previously reported, CMS developing a physician value-based payment modifier (Value Modifier), which was mandated by the ACA as a way to reward physicians for providing higher quality and more…
CMS Issues Final 2013 Medicare Physician Fee Schedule Rule, Including Other Part B Policy Updates
CMS has released its final rule updating the Medicare physician fee schedule (MPFS) for 2013 and modifying numerous other Medicare Part B policies. Most significantly, the final rule includes a 26.5% across-the-board cut in physician fee schedule payments as a result of the statutory sustainable growth rate (SGR) formula. While Congress is widely expected to mitigate this policy in future legislation, the timing and scope of any such “fix” is highly uncertain. The following are highlights of the sweeping rule:Continue Reading CMS Issues Final 2013 Medicare Physician Fee Schedule Rule, Including Other Part B Policy Updates