Under regulations proposed earlier this year, physicians will face up to a 4% fee schedule reduction in 2019 for failure to meet the reporting requirements of the new Quality Payment Program in 2017. Now the Centers for Medicare and Medicaid Services (CMS) has announced that it is going to revise those proposed regulations to make it easier to avoid the negative adjustment and perhaps even earn a slight positive adjustment in 2019. The final rules will be published around November 1, 2016 and will take effect on January 1, 2017.
This year is the final reporting period under the now-familiar Physicians Quality Reporting System (PQRS). The Centers for Medicare and Medicaid Services (CMS) just announced proposed regulations that will govern new Medicare quality-reporting rules known as the Quality Payment Program (QPP) beginning in 2017. This new system, which was enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), comprises both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). The final rules will be published later this year, but physicians can begin now to explore whether they want to join an APM or adapt to the MIPS reporting requirements.
The Centers for Medicare and Medicaid Services (CMS) issued two reminders recently that physicians must be working constantly to maintain compliance with the Medicare quality reporting programs. The current regulations call for adjustment of the fees paid to physicians for services to Medicare patients based on annual measurement of the physicians’ performance under quality and cost metrics. Radiologists must focus on their quality measures because the system assigns them to an Average Cost pool by default since they have little or no control over this factor.
At Healthcare Administrative Partners, our mission is to educate practices on CMS Quality Programs and provide a path to optimized performance even in the most challenging markets. This is the final installment of our series of articles, “A Program for Successful PQRS Participation for Radiology Practices,” which was specifically designed to help you maximize reimbursement and reduce compliance issues under the Physician Quality Reporting System (PQRS). So far we’ve covered...
If yours is one of the 70 group practices that achieved either average quality and low cost, or high quality and average cost under PQRS, then you are receiving 15.92% more reimbursement this year under the Medicare fee schedule. The Medicare Value-Based Payment Modifier (VM) provides upward adjustments to the basic Medicare fee schedule for higher-performing practices, and it is in effect in 2016 for groups of 10 or more physicians based on their Physician Quality Reporting System (PQRS) performance during 2014. The Centers for Medicare and Medicaid Services (CMS) reports that there were an additional 58 groups treating high-risk beneficiaries that qualified for a 31.84% increase in this year’s Medicare reimbursement for meeting these same criteria. The VM system applies to groups of 10 or more Eligible Professionals (EP) for this year, but it will apply to all physicians beginning in 2017 based on PQRS reporting for 2015. PQRS reporting this year (2016) will determine payment adjustments in 2018.
Now that 2016 is in full-swing, the new realities of our changing healthcare economy are becoming very apparent to providers across all specialties, and radiology is no exception. As physician practice leaders, assessing how to maintain and grow your practice as the transition to value-based compensation continues is not an easy task. At Healthcare Administrative Partners, our mission is to educate practices on these matters and provide a path to optimized performance even in the most challenging markets. Our continuing series of articles, “A Program for Successful PQRS Participation for Radiology Practices,” is specifically designed to help you maximize reimbursement and reduce compliance issues under the Physician Quality Reporting System (PQRS). So far we’ve covered:
Congress has mandated that the Centers for Medicare and Medicaid Services (CMS) move forward with quality-based programs and associated payment models. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, expanding the Medicare quality-reporting programs that began as a voluntary incentive ten years ago with the original Physician Quality Reporting Initiative (PQRI). Today it is more important than ever to embrace and maximize success in these programs and be ready to move ahead as they evolve.
The reporting of quality measures to Medicare will continue to be a high priority for radiology practices in the years to come. The current Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) are integral parts of the new Merit-Based Incentive Payment System (MIPS). Medicare payments in 2019 will be the first that are computed under MIPS, which will use 2017 data collection for the calculation of the 2019 increases or decreases from the basic Medicare fee schedule. Physicians’ participation in PQRS and VM in 2015 and 2016 will affect their reimbursement under these programs for payment years 2017 and 2018, respectively.
A variety of federal legislative activities during 2014 and 2015 contained rulings that will begin to affect Medicare reimbursement to physicians next year. Most recently, The Centers for Medicare and Medicaid Services (CMS) issued its Medicare Physician Fee Schedule (MPFS) Final Rule for 2016 that will govern its payments to physicians. The overall impact of the final MPFS changes to radiology and radiation oncology practices compared with the proposed changes issued earlier this year, is estimated by CMS as follows:
Every physician in the Medicare program will be subject to a potential adjustment of his or her Medicare fee schedule beginning in 2017 because of a provision in the Affordable Care Act known as the Medicare Value-Based Payment Modifier (VM). Physician groups of 100 or more Eligible Professionals are subject to the VM in 2015, the first time the VM is being applied since it became part of the Medicare law. The fee schedule adjustments can be upward, neutral or downward depending on a variety of factors, and the Centers for Medicare and Medicaid Services (CMS) has issued a report summarizing the characteristics and performance of the groups subject to the 2015 results. What can the results of this first year’s calculations tell us about what might happen in future years?