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...
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?
This article continues our series detailing why it is now more important than ever for radiology practices to develop a compliance plan and participate in Medicare’s Physician Quality Reporting System (PQRS). It is now settled law that successful PQRS participation in 2015 will affect your 2017 reimbursement under the Medicare Value-Based Payment Modifier (VM) program. Recent legislation assures that PQRS and VM will remain a major component of the Medicare payment structure far into the future, so there is no longer any reason for radiology practices to delay implementing a compliance plan.
Participation in Medicare’s Physician Quality Reporting System (PQRS) is now more important than ever since successful participation will affect future reimbursement under the Medicare program. A review of our recent articles, An Overview of the Medicare Quality Reporting Provisions Affecting Radiology Practice Reimbursements, and The Fundamentals of PQRS and VM for Radiology Practices, will provide you with a good background on the reasons PQRS has become so important. Legislation enacted as recently as April 16, 2015 builds on the current quality reporting program and assures that it will remain a major component of the Medicare payment structure far into the future.
The Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier (VM) are two components of the Medicare quality initiative that are coming together to affect Medicare reimbursement to all physicians. Our recent article, An Overview of the Medicare Quality Reporting Provisions Affecting Radiology Practice Reimbursements, provides a summary of the current status of these two programs.
The stage is set for a new era of Medicare payment modification using data self-reported by physicians that measures the quality of their work. The two programs already in place are the Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier (VM). These two will work in concert to determine either a positive, neutral or negative payment adjustment to the basic Medicare fee schedule, generally two years following the reporting year. Note that the rewards and penalties for these programs are cumulative; failure to meet the PQRS reporting requirements will invoke a penalty under both the PQRS and the VM programs.