by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
November 21st, 2014
CMS is aligning the way providers are paid to reward value rather than volume.
- Paying providers for quality, not quantity of care. In 2015, Medicare is continuing to phase in the Value-based Payment Modifier, which adjusts traditional Medicare payments to physicians and other eligible professionals based on the quality and cost of care they furnish to beneficiaries. Those adjustments translate into payment increases for providers who deliver higher quality care at a better value, while providers who underperform may be subject to a payment reduction.
- Providing incentives to hospital outpatient departments and facilities to deliver efficient, high-quality care. The Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS) rule includes provisions that promote greater packaging of payments for items and services rather than making separate payments for each individual service. For example, a new comprehensive Ambulatory Payment Classifications payment policy is being implemented in CY 2015 to make a single payment for all related hospital items and services provided to a patient receiving certain device-dependent procedures, such as insertion of a pacemaker, rather than separate payments for each supportive service, such as routine tests and diagnostic procedures.
To read the entire article on the final rule released October 31, 2014 outlining how Medicare will pay major health care providers and suppliers in 2015, click here.