Is Your Practice Ready for CMS Reimbursement Changes?

Posted by Continuum on Mar 29, 2016 11:00:00 AM

Changes to Medicare will soon have a major impact on physicians’ bottom lines.The Centers for Medicare and Medicaid
Services (CMS) is fast-tracking its shift to value-based payments, with the introduction of new regulations, reporting requirements and financial consequences.

As a result, physicians could experience a substantialConcernd_doctor_iStock_000080403937_XXXLarge.jpg difference in their Medicare Part B payments. Whether that change is positive or negative,though, depends upon their preparedness.

For most private-practice physicians, the situation demands immediate attention. That’s because each year’s reported data – for 2016 and beyond – will affect payments two years later. Moreover, Medicare is switching from an incentive-based system to one with mounting penalties. Independent practices are especially vulnerable due to the complexity of these changes. Larger practices will be affected first, then smaller groups, and finally, solo practitioners.

Act Now -- Or Lose Ground

Doctors can take incremental steps to get ready, but it's vital to move forward now. For physicians, it’s sink-or-swim time. The waters of this paradigm shift are about to surge dramatically and will continue to rise each year after 2016.Virtually all doctors will be affected by these changes, which include substantial penalties for those who underperform on quality and cost measures in comparison to their peers. On the plus side, physicians who perform well under the new rules will receive additional reimbursement from Medicare.

Right now, doctors should prioritize two essential constructs that will affect their Medicare payments: the Value-Based Payment Modifier (VBM) and the Merit-Based Incentive Payment System (MIPS). Each will have a profound impact, starting with VBM and building to the more complex, higher-stakes MIPS. Both are addressed below.

Learn more about how to maximize the VBM adjustment, as well as strategies for thriving under the new Merit-Based Incentive System (MIPS) by downloading our whitepaper: How Physicians Can Win in the New Healthcare Environment: 2016 is a Key Year to Act -- Or Lose Ground.

VMB: What You Need to Know

CMS began using the VBM in 2015, starting with groups of 100-plus eligible professionals (EPs). In 2017, VBM will be applied to all EPs, regardless of practice size. However, the amount of potential payment adjustments is linked to the size of the group: larger practices can have greater swings than smaller practices.

In the 2015-reporting/2017-payment year, for example, groups with 10 or more providers that deliver low quality and high costs will receive a 4% penalty on their Medicare Part B payments. The following year – 2016-reporting/2018-payment – all physicians will be subject to a positive, negative or zero (no) adjustment, based on their quality and cost data. CMS will calculate the annual adjustment percentages for 2018 and beyond once it collects all data nationally for the corresponding reporting year.

Learn more about how to maximize the VBM adjustment, as well as strategies for thriving under the new Merit-Based Incentive System (MIPS) by downloading our whitepaper: How Physicians Can Win in the New Healthcare Environment: 2016 is a Key Year to Act -- Or Lose Ground.

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Topics: Value-Based Modifer, Merit-Based Incentive Payment System, MIPS, CMS, Medicaid

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