decisionhealth Newsletters, Coder Pink Sheets - 2015 Issue 9 (September)
Value payment calculations could hit every practice with at least one doctor
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Article Overview
This article reviews CMS’ proposed 2016 guidance on the value-based payment modifier for physician practices that bill under a single tax ID number. It explains the broader policy context involving PQRS, group participation reporting, and the categories and thresholds used to determine whether a practice may face an upward, downward, or neutral payment adjustment. The piece is aimed at physician practices, billing staff, and coding/compliance professionals who need to understand how the proposed approach affects groups with physicians and non-physician practitioners.
Why This Topic Matters
The proposed methodology could affect payment for a wide range of practices, so understanding the reporting and grouping framework helps organizations assess exposure and prepare for future performance-based adjustments.
What You Will Learn
- How CMS frames the value-based payment modifier in relation to PQRS participation
- Which broad practice groups are affected by the proposed approach
- How CMS considers group structure and tax ID information when determining payment adjustment categories
- What payment adjustment ranges are discussed for different practice sizes
- How proposed reporting and enrollment information may influence a practice’s classification
Who Should Read This
- Physician practices
- Practice managers
- Medical billing professionals
- Coding and compliance staff
- Healthcare consultants
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