BC Advantage - 2015 Issue 5

Medicare Rules: What You Need to Know About the Value-Based Modifier

The Affordable Care Act requires CMS to begin applying a new modifier known as the "value-based modifier" in 2015, part of its ongoing effort to move away from fee-for-service towards pay-for-performance. For 2015, the modifier will only apply to physicians who are in a group of 100 or more participating providers, but this program will ramp up quickly over the next few years, so it's important you understand how it will affect you. The value modifier will use both cost and quality data to differentiate payment to a physician or group of physicians under the Medicare fee schedule. The...

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