CMS reported physicians in 128 groups will receive a reimbursement rate jump due to superior performance in the value-based payment program, paid for by the 5,477 groups that will see a 2 percent payment cut for poor performance or non-reporting, according to a Medscape report.
Here are five key notes:
1. The value-based modifier program will likely result in around $79.5 million in higher revenue; penalties for the groups that didn't meet the mark are also expected to total $79.5 million.
2. The payment adjustments go into effect on March 14 and providers will see the adjustment on claims over the next six weeks. The majority of providers won't see a change in their pay; they reported and met the requirements, or there was insufficient data to calculate the value modifier.
3. The value based modifier program adjusts Medicare reimbursement based on quality and cost-effectiveness. Any provider was eligible for the bonus, but the modifier with the penalty risk was automatically applied to groups of 100 eligible providers last year and those with 10 or more eligible providers this year.
4. The value based modifier will be folded into the Merit-Based Incentive Payment System in 2019, which eliminates the sustainable growth rate for physician reimbursement. MIPS is also absorbing the electronic health record meaningful use and Physician Quality Reporting System programs in 2019.
5. This year, 98 percent of the adjustments are negative.