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How To Avoid Quality Reporting Penalties

April 18, 2016

This reporting year for 2016 PQRS will be very critical for group practices according to the Centers for Medicare & Medicaid Services (CMS) in order to avoid penalties under the Value Based Payment Modifier (VBPM) in 2018.

Penalties will be based on quality outcomes and cost measures from the previous 2 years’ performance.

How does this relate to you? CMS will consider a group practice’s size to calculate payment adjustment. Group practices with fewer than 9 eligible professionals (EPs) and solo practitioners could see payment adjustments ranging from +2.0X to -2.0%. Groups with 10 or more EPs could see an adjustment of +4.0X to -4.0% with “X” representing the adjustment factor calculated to redistribute the total VBPM (Value-Based Payment Model) penalties collected. The “X” can vary annually so that CMS can ensure that the program remains budget neutral.

Also, groups that earn bonus payments will be eligible for an additional one-time payment increase if they provide care to high-risk Medicare patients. Note: The “X” in the VBPM adjustment factor is separate from the added one-time bonus payment for providers who care for high-risk patients.

CMS expanded the Value-Based Payment Model to affect not only the Practitioners but their extenders as well. That includes, the physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists based on the 2016 cost and quality data.

This will become a reality during the 2018 calendar year. Remember, participation in PQRS this year is critical for avoiding payment penalties under the Value-Based Modifier Program in 2018.

For more information concerning this topic, you may contact Health First Network Medical Management Department at 850-438-0818.

Reference: MGMA Connection: March 2016

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