BY REED TINSLEY, CPA, CVA, CFP, CHBC
The Centers for Medicare & Medicaid Services (CMS) is continuing to phase in a Value Modifier under the Medicare Physician Fee Schedule. The Annual Quality and Resource Use Report shows how your group or solo practice, as identified by its Medicare-enrolled Taxpayer Identification Number (TIN), performed in 2014 (most recent report available) on the quality and cost measures used to calculate the Value Modifier in 2016.
Any applicable Value Modifier payment adjustment is separate from payment adjustments made under the Physician Quality Reporting System (PQRS) or other Medicare programs.
About the 2016 Value Modifier
In 2016, the Value Modifier will apply to physician payments under the Medicare Physician Fee Schedule for physicians billing under TINs with 10 or more eligible professionals (at least one of whom is a physician). The 2016 Value Modifier will not apply to TINs with one or more physicians who participated in the Medicare Shared Savings Program, the Pioneer ACO Model, or the Comprehensive Primary Care Initiative in 2014.
If a TIN met the criteria as a group to avoid the PQRS, payment adjustment in 2016, or if at least 50 percent of its eligible professionals met the criteria as individuals to avoid the PQRS payment adjustment in 2016, then it’s 2016 Value Modifier will be calculated based on the TIN’s quality and cost performance in 2014, using CMS’ quality tiering methodology. Depending on performance, this could result in an upward or neutral payment adjustment for TINs with between 10 and 99 eligible professionals, or an upward, neutral, or downward payment adjustment for TINs with 100 or more eligible professionals. The Value Modifier payment adjustment is in addition to any PQRS incentive the TIN, or eligible professionals in the TIN, may earn.
If a TIN did not meet the criteria as a group to avoid the PQRS payment adjustment in 2016, or if at least 50 percent of the eligible professionals did not meet the criteria as individuals to avoid the PQRS payment adjustment in 2016, then its 2016 Value Modifier will be set at -2.0%, (downward payment adjustment).
Beginning in 2017, the Value Modifier will apply to all physicians in groups with two or more eligible professionals, and to physicians who are solo practitioners who bill under the Medicare Physician Fee Schedule.
How to Get a QRUR
You can access a QRUR on behalf of a group or solo practitioner at https://portal.cms.gov. As mentioned, QRURs are provided for each Medicare-enrolled Taxpayer Identification Number (TIN). You or one person from your group will need to obtain an EIDM account with the correct role first. The sections below “Setting up an EIDM account to access a group’s QRUR” and “Setting up an EIDM account to access a solo practitioner’s QRUR” will tell you how. Once you have an EIDM account with the correct role, follow the step-by-step instructions provided in the reference guide located in the “Downloads” section below, to access the QRUR.
For more information about the Value Modifier, please visit: