PQRS: Who is eligible and affected by the Value Modifier Program in 2016
March 3, 2016
Written by Sarah Leake
Don’t forget about the Value Modifier Program as professionals affected by this program are different than for the PQRS program. Beginning January 1, 2018, the Value Modifier will be applied to physician payments under the Medicare PFS for physician solo practitioners and physicians in groups with two or more eligible professionals, as identified by their TIN. CY 2016 is the performance period for the Value Modifier that will be applied in 2018.
In addition to physicians, the Value Modifier will be applied to nonphysician – EPs who are Physician Assistants (PAs), Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), and Certified Registered Nurse Anesthetists (CRNAs) (and not to other nonphysical EP types) in groups and to PAs, NPs, CNSs, and CRNAs who are solo practitioners, in the CY 2018 payment adjustment period.
Of course there is a twist to this. The Value Modifier will be applied to all groups and solo practitioners and would be subject to upward, neutral, or downward adjustments derived under the quality-tiering methodology. BUT for groups or solo practitioners consisting of only PAs, NPs, CNSs, and CRNAs – they will be held harmless from downward adjustments under the quality-tiering methodology in CY 2018.
On another note, VM is waived if at least one EP billed for PFS items and services under TIN during 2016 year in Pioneer ACO Model, Comprehensive Primary Care Initiative (CPCI) or other similar innovation center models.
CMS web page on Value-Based Payment Modifier
Leave a reply, ask a question or share information using the “Leave a Reply” section below, or email Sarah Leake directly with your questions or comments.