For the Week of August 18, 2014
To what providers does the value-based payment modifier apply?
The Affordable Care Act required the Centers for Medicare & Medicaid Services (CMS) to establish a value modifier that provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS) based upon the quality of care furnished to Medicare beneficiaries compared to the cost of that care during a performance period. CMS will begin applying the modifier on January 1, 2015, with respect to items and services furnished by specific physicians and physician groups; it will apply to all physicians and physician groups beginning no later than January 1, 2017.
For 2015 and 2016, the value modifier does not apply to groups of physicians in which any of its physicians participate in the Medicare Shared Savings Program, the Pioneer ACO model, or the Comprehensive Primary Care Initiative.
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