Outpatient Facility Coding Alert - 2006 Issue 5
PAY-FOR-PERFORMANCE: Quality Is Still Its Own Reward Under Medicare
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Article Overview
This article explains the Medicare policy environment surrounding pay-for-performance, including budget developments, disagreements in Congress, CMS expectations, and a separate voluntary physician quality-reporting program. It is relevant to physicians, coders, compliance staff, and revenue cycle professionals watching Medicare reimbursement policy and quality-reporting initiatives.
Why This Topic Matters
The piece helps readers understand how pending Medicare payment policy changes and quality-reporting programs could affect physician reimbursement and administrative workload.
Article Sections
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Pay-for-performance program is looking a lot less likely
Introduces the Medicare budget context and the uncertainty surrounding pay-for-performance proposals.
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Deadlocked
Summarizes congressional disagreement over Medicare payment policy, the Sustainable Growth Rate issue, and unresolved questions about how a potential program would operate.
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Bad sign
Describes CMS’s voluntary physician quality-reporting initiative and the concerns raised about participation and program design.
What You Will Learn
- How Medicare budget actions affected the outlook for pay-for-performance
- What policy disagreements were affecting the proposed Medicare quality program
- Why a CMS voluntary quality-reporting initiative was relevant to future payment policy
- How physician participation concerns influenced the discussion
- What broader reimbursement and administrative issues were being debated
Who Should Read This
- Physicians
- Medical coders
- Compliance professionals
- Revenue cycle staff
- Practice managers
- Healthcare policy readers
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