decisionhealth Newsletters, Part B News - 2015 Issue 7 (July)
Value payment calculations could hit every practice with at least one doctor
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Article Overview
This article covers CMS guidance in the 2016 proposed physician fee schedule on how the value-based payment modifier may apply to physician practices under a single tax ID number. It is relevant to physicians, group practices, billing staff, and compliance teams tracking PQRS participation and payment adjustment exposure. The discussion focuses on broad eligibility categories, practice-size thresholds, and administrative counting methods that affect whether a practice may face a payment adjustment.
Why This Topic Matters
The proposed policy affects how many physician practices are evaluated for payment adjustments and how those practices are grouped for calculation purposes. Understanding the article helps practices assess their exposure, monitor reporting performance, and prepare for potential Medicare payment impacts.
Article Sections
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CMS guidance and proposed policy background
Introduces CMS’s proposed 2016 approach and the broader context for how the payment modifier is being applied. It also references the related reporting framework and legislative background.
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Understand what constitutes success
Summarizes the general eligibility categories CMS uses to treat a practice as successful for purposes of avoiding a negative adjustment. It describes the reporting pathways discussed in the proposal.
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Understand what’s at stake
Outlines the types of payment adjustments discussed in the proposal and how practice size affects the overall adjustment range. It also notes when the final adjustment is determined.
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CMS headcount will favor practices
Explains the proposed method CMS uses to count eligible providers under a tax identification number. It addresses how enrollment and claims information are considered when determining the applicable practice grouping.
What You Will Learn
- How CMS proposed to apply the value-based payment modifier to physician practices
- What broad reporting outcomes are relevant to the modifier calculation
- How practice size affects the range of possible payment adjustments
- How CMS may count providers under a single tax identification number
Who Should Read This
- Physicians
- Medical practice administrators
- Billing and coding staff
- Compliance officers
- Practice managers
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