Accept Medicare patients? A new incentive is here!

August 31, 2015

Accept Medicare patients? A new incentive is here!

If you accept Medicare patients, make sure you know about the Value Based Modifier (VBM). This is a new adjustment made on a per-claim basis that pays an incentive for providing patients with appropriate care for less when compared to care provided by peers to similar patients.

Physicians whose care is determined to be higher cost and/or lower quality can receive a penalty of up to four percent of their Medicare reimbursement. Medicare disseminates information on each physician’s quality and cost of care through a quality and resource use report (QRUR.) A QRUR article was published by the Advocacy Council of ACAAI (formerly JCAAI) late last year.)

You can access your QRUR to see how your performance in each of the quality measures compares to the mean for all solo or group practices nationwide. If you are in a group of 10 or more, the VBM already applies to you and your performance in 2014 determines your payment in 2016. Beginning in 2015, for performance year 2017, the VBM applies to all physicians.

In order to qualify for any incentives in 2017, you must participate in the PQRS system and satisfy reporting requirements – either as a group or individual in calendar year 2015.

If you have a small Medicare income, this might be a minor penalty that you can write off. However, for others, this penalty may represent a substantial portion of their Medicare income, as reported in a recent online article. Overall, it’s important for all allergists to participate in quality reporting activities because the Advocacy Council believes this type of reporting will be required by commercial payers in the future.

The take away?

You should:

  • Continue to participate in PQRS quality reporting and if you are not doing this currently, you should be.
  • Access your QRUR report and if you are not performing at a quality/cost level, take steps to improve your performance in this area.
  • Monitor your quality of care, especially when it comes to asthma admissions and readmissions.
  • Monitor the quality and cost of care you provide on a monthly basis.

Although the VBM will be folded into the new Merit-based Incentive Payment system beginning in 2018, Medicare payments will continue to be closely linked to measures of quality and cost. Now is the time to ensure that your practice is prepared for these future developments. Contact your Advocacy Council experts with any questions on this or other topics.