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Bellevue, WA—Mandated by the Affordable Care Act and first applied on January 1, 2015, to large group practices, the Value Modifier (VM) provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS), based on the quality of care furnished compared with cost during a performance period.
At the 2015 annual meeting of the National Organization of Rheumatology Managers, Emily L. Graham, Vice President of Regulatory Affairs at Hart Health Strategies in Washington, DC, discussed the specifics of this program, which will involve all groups and practices by 2017.
“The VM is an adjustment made on a per-claim basis to Medicare payments for items and services furnished under PFS,” said Ms Graham. “Depending on how well you perform on quality and cost, you could face a positive, a neutral, or a downward adjustment in certain years.”
As Ms Graham explained, the VM is applied at the Taxpayer Identification Number (TIN) level and pertains to all physicians and certain nonphysician eligible providers (EPs) billing under the TIN who are subject to the VM during the payment year.
“The performance year is always 2 years ahead of time,” she said. “Since we are in 2015 right now, your adjustment will take place in 2017.”
The maximum downward adjustment is –4.0%.
For those practices already participating in PQRS, Ms Graham underscored the importance of downloading the Quality and Resource Use Report from the portal.
“One of the most important things you can do is download your feedback report and do your best to understand it,” she concluded. “Is it easy to read? Absolutely not. Is it easy to download? Absolutely not. But this will give you at least some indication of what things look like for the VM calculation and where you fall in comparison to your peers.”
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