decisionhealth Newsletters, Coder Pink Sheets - 2016 Issue 12 (December)
Quality payment program: 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 within the quality payment program, with emphasis on how evaluation and management volume and non-physician practitioner activity can influence which practice TIN receives attribution. It is aimed at specialty practices, coding and compliance staff, and administrators who need to understand quality reporting results, review attribution data, and prepare for informal review processes. The article also discusses how to interpret quality/resource use reporting outputs and what broad types of data to examine when checking practice-level performance.
Why This Topic Matters
Attribution can materially affect a practice’s quality and cost profile, which in turn can influence payment adjustments and the need to challenge report results. Understanding the broad attribution framework helps practices assess whether reported patients and performance measures align with their actual care relationships.
Article Sections
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Patient attribution under CMS methodology
Explains the general CMS approach to assigning patients to primary care and specialty practices for quality and resource use reporting. Covers the categories of providers and practice identifiers involved in attribution.
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Reviewing 2015 report results and preparing for 2016
Outlines the types of report elements practices are encouraged to review and the broad steps involved in checking attribution and performance data. Includes discussion of informal review timing and the need to assess current-year claims activity.
What You Will Learn
- How CMS generally attributes patients for quality reporting purposes
- Which broad provider types are included in primary care attribution
- Why non-physician practitioner activity can affect practice attribution
- What report components practices are told to review for attribution concerns
- How practices can prepare for a reported-results review process
Who Should Read This
- Specialty practices
- Physician administrators
- Coding and billing staff
- Compliance staff
- Quality reporting staff
Codes Discussed
Modifiers Discussed
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