decisionhealth Newsletters, Part B News - 2018 Issue 2 (February)
Value modifier cuts hit 59% of practices; some results translate to MIPS
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Article Overview
This article covers Medicare physician payment adjustments tied to the value modifier program and explains how prior performance-year results carry into later payment years. It also places those outcomes in the context of MIPS, including broad reporting thresholds, low-volume exclusion changes, and cost-category scoring. The piece is relevant to physician practices, practice managers, and coding/billing professionals tracking CMS quality and payment programs.
Why This Topic Matters
It helps readers understand why Medicare reimbursements may differ from expected rates and how earlier quality and cost performance programs can influence later-year payment results under MIPS.
Article Sections
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Quality reporting
Overview of the payment-adjustment landscape and the relationship between earlier CMS quality programs and MIPS.
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Small practices bear the brunt
Discussion of how the payment changes are distributed across practice sizes and the broader impact on small or solo groups.
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Scoping the 2018 outlook
General guidance on connecting prior performance information to later MIPS scoring and the broader policy context for the cost category.
What You Will Learn
- How Medicare payment adjustments from prior value modifier results may affect later reimbursement
- How the article relates the value modifier program to MIPS and other CMS quality initiatives
- What broad practice-size trends are associated with the reported payment changes
- How CMS thresholds and cost-category changes are discussed in the context of future reporting years
Who Should Read This
- Physician practices
- Practice managers
- Medical billers
- Medical coders
- Revenue cycle professionals
- Compliance staff
Codes Discussed
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