Getting paid: SGR is gone but quality reporting, globals and ICD-10 are here to stay

Why This Topic Matters

These policy changes affect how physician practices are paid, how quality performance is measured, and how reporting obligations evolve over time. It also highlights timing issues tied to Medicare payment reform and the ICD-10 implementation schedule, which are important for planning and compliance.

Article Sections

1. Medicare payment certainty and new reform challenges

   Introduces the repeal of the sustainable growth rate and the broader Medicare payment framework that replaces recurring temporary fixes. Summarizes the general direction of the new law for physician practices.

2. ICD-10 and surgical global period policy

   Covers the ICD-10 implementation timeline and policy changes affecting surgical global periods and related federal review activity. Focuses on timing and oversight developments relevant to procedural services.

3. Therapy cap exceptions and medical review updates

   Describes extensions and administrative changes tied to Medicare therapy services, including review-related updates. Addresses how the law modifies the prior approach to claim oversight.

4. Physician payment updates through 2025 and beyond

   Summarizes the payment schedule for physicians over the coming years and notes longer-term conversion factor changes under MACRA. Emphasizes the general payment timeline and structure.

5. Quality reporting programs combined into MIPS

   Explains the consolidation of multiple quality and health IT incentive programs into a single reporting system beginning in 2019. Describes the broad performance categories and the shift from separate program adjustments.

6. Payment adjustments and APM incentives

   Outlines the new performance-based adjustment framework and the separate incentives tied to participation in alternative payment models. Highlights how participation status affects future Medicare incentives.