decisionhealth Newsletters, Part B News - 2016 Issue 11 (November)
CMS attributes patients to specialties based on E/M volume, NPPs’ work
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Article Overview
This article covers CMS patient-attribution methodology as it relates to QRUR review for physician practices, especially specialty groups. It explains the broad framework CMS uses to assign patients for quality and resource use purposes, why attribution can affect value-based modifier exposure, and which practice-level reports and claims data should be reviewed by affected providers. It is intended for physicians, specialty practices, practice managers, and coding or quality reporting staff who work with Medicare reporting and performance review.
Why This Topic Matters
Patient attribution can affect how CMS evaluates practice performance and the resulting quality-related reporting consequences. Understanding the attribution framework helps practices review their data, identify potential mismatches, and prepare for reporting deadlines and appeals.
Article Sections
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Quality reporting
An overview of the reporting context and why attribution issues matter for specialty practices reviewing performance results.
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Act now — check 2015 report, 2016 data
Practical guidance on reviewing report data, attribution rosters, and current-year claims information to assess practice impact.
What You Will Learn
- How CMS attribution is discussed in the context of QRUR review
- Which provider categories CMS considers in its patient-attribution framework
- Why specialty practices may need to review quality and resource use reporting data
- What practice-level report elements are highlighted for review
- How current-year claims information can affect attribution review
Who Should Read This
- Physicians
- Specialists
- Practice managers
- Quality reporting staff
- Medical coders
- Compliance staff
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