National Provider Call: CMS Proposals for the Physician Value-Based Payment Modifier Under the Medicare Physician Fee Schedule

CMS will provide an overview of its proposals for the physician value-based payment modifier on the National Provider call scheduled August 1, 2012. CMS has proposed to phase-in application of the value modifier, starting in 2015 with groups of physicians with 25 or more eligible professionals. The value modifier for these groups would be based on performance during 2013. The presentation will describe the options these groups have on how the Value Modifier would be calculated based on whether they participate in the Physician Quality Reporting System (PQRS). For groups of 25 or more that do not participate in the PQRS, CMS is proposing to set their Value Modifier at a 1.0 percent payment reduction. For groups that wish to have their payment adjusted according to their performance on the value modifier, the rule proposes a system whereby groups with higher quality and lower costs would be paid more, and groups with lower quality and higher costs would be paid less.