Outpatient Facility Coding Alert - 2016 Issue 6
Medicare: Pay for 'Quality' Here to Stay
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Article Overview
This article explains how Medicare payment is moving toward performance-based models under MACRA, with emphasis on MIPS, APMs, and the transition away from older quality reporting programs. It is aimed at physicians and practice administrators who need a broad understanding of how reporting, scoring, and payment adjustment programs fit together, especially in general surgery settings. The piece also summarizes why current quality programs still matter during the transition period and highlights the kinds of program updates and reports practices should watch.
Why This Topic Matters
Physician practices need to understand the shift from fee-for-service toward quality-linked payment so they can follow current reporting requirements and prepare for future Medicare adjustments. The article helps readers see how multiple Medicare quality initiatives relate to one another during the transition period.
Article Sections
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Learn the Quality/Payment Plan
Introduces the new Medicare payment framework and the broad categories of performance information used in it. Also describes related CMS planning and the relationship between newer and older quality initiatives.
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Keep Current with PQRS
Covers the continuing role of the physician quality reporting program during the transition period and notes specialty-relevant measure categories for surgical practices. It also summarizes the potential impact of participation status on future payment adjustments.
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Take a Closer Look at the 2016 VBM
Explains the value-based payment component, including how it is applied and the types of performance comparisons it uses. This section also addresses reporting status, feedback reports, and the program’s transition timing.
What You Will Learn
- How MIPS fits into Medicare payment reform
- Which existing Medicare quality programs are being consolidated during the transition
- Why APM participation is linked to quality measurement alignment
- How current physician reporting and feedback programs affect payment adjustments
- What broad types of performance domains are included in the new framework
Who Should Read This
- Physicians
- General surgeons
- Practice administrators
- Medical coders
- Quality reporting staff
- Billing and reimbursement staff
Codes Discussed
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