decisionhealth Newsletters, Part B News - 2015 Issue 3 (March)
House kicks SGR to the curb, sets new payment path, eases quality reporting
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Article Overview
This article explains a major Medicare payment reform package and why it matters to physicians, practices, and coding/billing professionals who follow Medicare reimbursement policy. It covers the transition away from the sustainable growth rate framework, the shift from several quality and reporting programs to a new performance-based system, incentives for advanced payment model participation, and the introduction of care management payment policy for chronic conditions. The piece is useful for readers tracking physician payment updates, quality reporting changes, and broader reimbursement direction.
Why This Topic Matters
The legislation described in the article affects Medicare physician payment, quality reporting, and participation in alternative payment models, so it is important for practices planning for reimbursement and compliance changes.
Article Sections
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House action on Medicare payment reform
Summarizes the House vote and the broader legislative effort to replace the existing physician payment framework. It also introduces the time period and payment outlook addressed by the bill.
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Payment updates and conversion factors
Describes the schedule of Medicare payment changes across multiple years and the separate treatment of advanced payment model participation versus other providers.
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Combine PQRS, MU programs but teeth remain
Explains the consolidation of existing quality and health IT incentive programs into a new performance-based system. It outlines the categories used for evaluation and the general structure of resulting payment adjustments.
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Benefits of advanced models
Covers incentives available to providers participating in alternative delivery and payment arrangements. It also addresses how those participants relate to the new performance system.
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Expect new code for chronic care
Discusses new payment policy for chronic care management services and related billing context. The section notes how the legislation frames services for individuals with chronic conditions.
What You Will Learn
- How federal physician payment reform changes the overall Medicare reimbursement landscape
- How quality reporting programs are being consolidated into a new performance-based approach
- How participation in advanced payment models is treated under the new framework
- How chronic care management payment policy is being expanded in the legislation
- Which provider groups are most affected by the transition in reporting and incentives
Who Should Read This
- Physician practices
- Medical billing and coding professionals
- Practice administrators
- Compliance staff
- Healthcare policy analysts
- Revenue cycle teams
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