Value-Based Modifier ProgramHow well do you understand CMS’ Value-Based Modifier program? Make sure you understand this new program that will result in payment adjustments, because it will begin impacting your practice with your 2015 performance. Take our quick quiz to make sure you understand what this program means to your practice and what you need to do.

Quiz

1. When will the Value-Based Modifier be applied to all practices and used to adjust future Medicare payments?

A. 2017

B. 2015

C. 2016

2. The Value-Based Modifier is calculated using:

A. Total Costs per Beneficiary

B.  A quality composite score and a value score

C. A quality composite score and a cost composite score

3. There is only potential for downward penalty adjustments under CMS’ Value-Based Modifier program.

A. True

B. False

4. The only way you can know how your practice will measure up under the Value-Based Modifier is:

A. Wait to see the penalty applied in 2017

B. Review your Quality Resource and Use Reports (QRURs)

C. Call your RAC for an assessment

5. QRURs are confidential reports that provide physicians with comparative information focusing on:

A. The portion of a provider’s Medicare fee-for-service (FFS) patients who have received indicated clinical services

B. How a provider’s patients have used various types of service such as inpatient hospital stays, outpatient visits to physicians, etc.

C. How Medicare spending for a provider’s patients compares to average Medicare spending across the region and specialty

D. All of the above

6. What can you do to prepare for the Value-Based Modifier program?

A. Nothing

B. Get new software for tracking your cost composite scores

C. Review your QRURs, check PECOS to make sure all practice data is correct, and report successfully for PQRS in 2015.

 

Answers

1. B – Starting in 2015, the performance of all providers who participate in Fee-For-Service Medicare will affect their 2017 Medicare payments.

2. C – The Value-Based Modifier is calculated using a quality composite score and a cost composite score. The quality composite score will be calculated based on measures reported through PQRS. “Quality Tiering” will determine if group performance is statistically better, the same, or worse than the national mean in order to reward or penalize a group based on quality and cost.

3. B – False. Groups with 2-9 providers and solo practitioners that do report successfully for PQRS will only receive an upward or neutral value-based adjustment for 2017—no downward adjustment. The upside potential is for an additional +1.0x if reporting clinical data for quality measures and average beneficiary risk score in the top 25 percent of all beneficiary risk scores. The “x” factor remains to be determined based on the downward adjustments for other providers.

4. B – The only way you can know how your practice will measure up under the Value-Based Modifier is to review your Quality Resource and Use Reports (QRURs) available on the CMS website.

5. D – QRURs are confidential reports that provide physicians with comparative information focusing on the portion of a provider’s Medicare fee-for-service (FFS) patients who have received indicated clinical services, how a provider’s patients have used various types of service such as inpatient hospital stays, outpatient visits to physicians, etc., and how Medicare spending for a provider’s patients compares to average Medicare spending across the region and specialty.

6. C – To prepare for the value-based modifier program, you should review your QRURs, check PECOS to make sure all practice data is correct, and report successfully for PQRS in 2015.

If your EHR software doesn’t provide the features you need for these important CMS programs, contact us today for an online demonstration of how MediTouch can make PQRS and Value-Based Modifier reporting simpler.

Additional Resources

Free webinar – The Value-Based Modifier Program: What’s the Impact on Your Practice?

Free infographic: What is CMS’ Value-Based Modifier Program and How Will It Affect Your Practice?

More information about the Value-Based Modifier program is available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/index.html

More information about the PQRS program is available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html