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News and Announcements

Value Modifier Transition to MIPS

Note: The final performance period for the Value Modifier program was 2016 and the final payment adjustment year is 2018. Therefore, the Quality and Resource Use Reports (QRURs) will no longer be available after the end of 2018. All QRURs provided under the Value Modifier program will remain available for download until December 31, 2018. Authorized representatives of groups and solo practitioners can access their QRURs at https://portal.cms.gov using an Enterprise Identity Management (EIDM) system account with the correct role. The QRURs can be downloaded as PDF or Excel files. For instructions on signing up for an EIDM account and accessing the QRURs, please visit the How to Obtain a QRUR webpage.

The Merit-based Incentive Payment System (MIPS) under the new Quality Payment Program replaced the Value Modifier program. We encourage everyone to learn more about the Quality Payment Program by visiting qpp.cms.gov. Please note that the QRURs are not the same as the MIPS Performance Feedback that is available under the Quality Payment Program.

2018 Value Modifier Program Experience Report is Available

The 2018 Value Modifier Program Experience Report highlights characteristics of the practices subject to the Value Modifier in 2018 and compares program results across 2015, 2016, 2017, and 2018. The report also includes the 2016 quality and cost measure performance for all practices subject to the 2018 Value Modifier, including their quality-tiering and payment adjustment category, quality reporting method, and performance by physician specialty.

2018 Value Modifier Results and Payment Adjustment Factor are Available

CMS applies an upward or neutral Value Modifier payment adjustment to 2018 Medicare Physician Fee Schedule payments to physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists based on the performance of their practice on quality and cost measures during the 2016 performance period. The 2018 Value Modifier adjustment factor that will be applied to groups and solo practitioners receiving an upward payment adjustment in 2018 is +6.6%. The Value Modifier payment adjustment factor is based on the estimated aggregate amount of downward payment adjustments.

For questions about the 2018 Value Modifier, contact the Physician Value Help Desk at 888-734-6433 (select option 4) or pvhelpdesk@cms.hhs.gov.

2016 Annual QRURs are Available

On September 18, 2016, CMS made available the 2016 Annual Quality and Resource Use Reports (QRURs) to every group practice and solo practitioner nationwide. The 2016 Annual QRURs show how physician, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists in groups and solo practitioners performed in 2016 on the quality and cost measures used to calculate the 2018 Value Modifier as well as their 2018 Value Modifier payment adjustment. Groups and solo practitioners may request an informal review of perceived errors in their 2018 Value Modifier calculation. Requests for an informal review of your 2018 Value Modifier calculation may be made during the informal review period between September 18, 2017 through December 1, 2017 8:00 pm Eastern Time. Additional information about the 2016 Annual QRURs and how to request an informal review is available on the 2016 QRUR and 2018 Value Modifier webpage.

Please note that the 2018 Value Modifier payment adjustments shown in the 2016 Annual QRURs are based on proposed policies that were included in the 2018 Medicare Physician Fee Schedule Proposed Rule (82 FR 34124) and are subject to change. Information on the Proposed Rule can be found at https://federalregister.gov/d/2017-14639.

Authorized representatives of groups and solo practitioners can access the 2016 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management account with the correct role.  For more information on how to access the 2016 Annual QRURs, visit the How to Obtain a QRUR webpage. For questions, contact the Physician Value Help Desk at 888-734-6433 (select option 4) or pvhelpdesk@cms.hhs.gov

New Payment Adjustment and Reports Lookup Feature  

There is a new feature available on the CMS Enterprise Portal that will allow a representative of a group or solo practitioner, as identified by its Medicare-enrolled Taxpayer Identification Number (TIN) to: (1) look up the TIN’s current and prior years’ Value Modifier and PQRS payment adjustments, and (2) find out which feedback reports are available for the TIN (i.e., the Annual QRUR, PQRS Feedback Report, Mid-year QRUR, and Supplemental QRUR). Please note that an EIDM account is not needed to use this feature. Instructions for using this feature are located in the “Guide for Accessing the Payment Adjustment and Reports Lookup Feature”.