The Affordable Care Act requires that CMS apply a value-based modifier (VBM) to Medicare
physician fee schedule payments starting with select physicians in 2015 and all physicians by. The VBM will adjust physician payments based on their performance on a composite of quality and cost measures.
How is Group Practice Defined?
A group is defined as a single Tax Identification Number (TIN) with 2 or more individual EPs,
identified by Individual National Provider Identifier (NPI), who have reassigned their billing
rights to the TIN. For purposes of determining group size for the VBM, EPs are defined as:
- Physician
- Physician assistant
- Nurse practitioner or clinical nurse specialist
- Certified registered nurse anesthetist
- Certified nurse-midwife
- Clinical social worker
- Clinical psychologist
- Registered dietitian or nutrition professional
- Physical or occupational therapist or a qualified
speech-language pathologist - Qualified audiologist
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