Health Information Management

News: Value-based payment modifier details released

CDI Strategies, November 10, 2011

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On November 1, CMS issued its Medicare Physician Fee Schedule (MPFS) for calendar year 2012. In it, CMS details the new “value-based payment modifier,” according to a Fact Sheet on the matter.

The “Value Modifier,” as required by the Affordable Care Act, compares the quality of care furnished to the cost of that care, to physician payment rates under the MPFS starting with specific physicians and physician groups in 2015 and expanding to all physicians by 2017. The Act also requires CMS to publish details regarding quality of care and cost measurements, as well as dates for implementation and information regarding the initial performance period, by January 1, 2012.
CMS will use performance data from calendar year 2013 as the initial performance period which would apply to items and services furnished during the 2015 MPFS. 
If physicians do not begin to pay closer attention to the affect of their documentation on quality and cost related to patient care, they could see reductions in payments based on the implementation of this modifier, says Glenn Krauss, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, an independent revenue cycle consultant based in Madison, WI and a member of the ACDIS advisory board.
“The importance of [complete and accurate] clinical documentation in the record is imperative for physicians to [understand]. They need to do this now to support their medical decision making and justification for service provisions, as well as ordered tests, since this information will be used to measure and adjust their payments for quality and costs of care in the very near future,” Krauss says.

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