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News and Announcements

2015 Value Modifier Results Are Now Available

The results from the implementation of the 2015 Value Modifier Results [PDF, 171KB] are available now. The results from the implementation of the 2015 Value Modifier are shown in the “2015 Value Modifier Results” document.  This document provides the adjustment factor for CY 2015 payment adjustments to physicians in groups with 100 or more eligible professionals that elected quality-tiering and earned an upward payment adjustment.  This document also provides information on the number of groups that are subject to the Value Modifier and how groups that elected quality-tiering performed under the 2015 Value Modifier.

Informal Review Request Closes Soon

We notified provider groups about the payment adjustments that will be made in 2015 under the Physician Value-Based Payment Modifier (VM) Program.  We will apply these adjustments to Medicare Physician Fee Schedule payments for physicians in some groups consisting of 100 or more eligible professionals, based on performance in 2013. We notified groups via their Medicare Quality and Resource Use Reports (QRURs).  Information on how to access your QRUR can be found at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Obtain-2013-QRUR.html.  Groups that disagree with the result of their 2015 VM payment adjustment have the option to submit an Informal Review request through the CMS Enterprise Portal at https://portal.cms.gov until March 2, 2015 at 8:00 pm EST.  For questions, please contact the Physician Value Modifier Helpdesk at 1-888-734-6433, option 3.

Registration

02/12/2015 Updates:

Between April 1, 2015 and June 30, 2015, group practices will be able to register to participate in the 2015 Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO) as a group. Authorized representatives of group practices will be able to select a PQRS GPRO reporting mechanism for 2015 in the Physician Value-Physician Quality Reporting System (PV-PQRS) Registration System during this period. More information will be available on PQRS GPRO Registration web page prior to the beginning of the registration period.

Immediate Action Needed for Groups with 10 or More Eligible Professionals to Avoid the Automatic 2016 Value-Based Payment Modifier Downward Payment Adjustment

In order to avoid an automatic negative two percent (“-2.0%”) Value Modifier payment adjustment in 2016, eligible professionals (EPs) in groups with 10 or more EPs MUST participate in the PQRS and satisfy reporting requirements as a group or as individuals in 2014. The deadline for groups to register to participate in the PQRS GPRO as a group in 2014 has passed. Therefore, in order to avoid the automatic "-2.0%" Value Modifier payment adjustment in 2016, groups with 10 or more EPs that did not register to participate in the PQRS GPRO in 2014, must ensure that at least 50% of the EPs in the group participate in the PQRS as individuals in 2014 and meet the satisfactory reporting criteria as individuals via a qualified PQRS registry, or EHR (or in lieu of satisfactory reporting, satisfactorily participate in a Qualified clinical data registry) to avoid the 2016 PQRS payment adjustment. Information on how EPs in a group can participate in the PQRS as individuals in order to avoid the 2016 PQRS payment adjustment and the CY 2016 Value Modifier payment adjustment can be found here.

CMS has released the 2013 Quality and Resource Use Reports (QRURs)

On September 30, 2014, CMS made available the 2013 Quality and Resource Use Reports (QRURs) to solo practitioners and group practices nationwide who met two criteria: (a) at least one physician billed under the TIN in 2013, and (b) the TIN had at least one eligible case for at least one of the quality or cost measures included in the QRUR.  The 2013 QRURs contain quality of care and cost performance data for calendar year 2013 on measures that will be used to compute the value-based payment modifier in 2015. For groups of 100 or more EPs, the 2013 QRUR show how a group’s payments will be affected by the VM including any upward, neutral or downward payment adjustment if the group elected the quality tiering option.  These reports are available at: https://portal.cms.gov.  For more information on the 2013 QRURs, select New* 2013 QRUR (disseminated 9/14) on the left side of this page.