Physician Value-Based Payment Modifier
What Neurosurgeons Need to Know for 2016
The Affordable Care Act required CMS to begin applying a value-based modifier (VM) to
Medicare physician fee schedule payments for all physicians starting in 2017. The VM
adjusts payments to groups of physicians based on their performance on a composite of
quality and cost measures.
Determining 2018 Payment Adjustments
Non-PQRS Reporters in 2016
As illustrated below, all physician and select non-physician eligible professionals (EPs)
must, at a minimum, satisfy Physician Quality Reporting System (PQRS) reporting
requirements in 20161 to avoid a separate payment adjustment under the VM in 2018.
Failure to do so will result in an automatic Medicare payment penalty of -2.0% to -4.0%,
depending on group practice size.
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