CMS announces 2015 Value-Based Payment Modifier results 

On Feb. 27, the Centers for Medicare & Medicaid Services (CMS) announced the results from the implementation of the first phase of the Value-Based Payment Modifier (VBPM). This year, groups with 100+ eligible professionals (EPs) are subject to, a payment increase or no adjustment on their 2015 Medicare payments based on cost and quality information from 2013. Under the VBPM, all groups and solo practitioners will see their Medicare payments modified in 2017 based on the cost and quality of care provided in 2015.The VBPM results indicate that 1,010 groups are subject to the VBPM in 2015. Three hundred and nineteen of these groups will receive an automatic -1% penalty because they did not register to report for PQRS as a group via registry or web interface or elect the administrative claims group reporting option under PQRS in 2013. PQRS determines the quality component of the VBPM. In addition, out of the remaining 691 groups that did satisfactorily participate in PQRS or report as a group via the PQRS administrative claims reporting option, 127 groups elected to have CMS calculate the VBPM using the quality-tiering methodology that will be mandatory in 2017. Of these 127 groups:

14 received an upward adjustment to their 2015 payments 
11 received a penalty of -0.5% or -1.0% to their 2015 payments 
102 received no adjustments to their 2015 payments (21 of which did not have enough cost or quality data from 2013 for CMS to calculate the VBPM)

The cost and quality measures used to determine the VBPM are outlined in the Quality and Resource Use Reports (QRURs). For a brief overview of the information included in the QRURs, click here. To learn more about how to prepare your practice in 2015 ahead of the 2017 VBPM, visit MGMA’s members-only resource The Value-Based Payment Modifier: How to Prepare Your Practice. 

New CMS ICD-10 testing opportunities and educational resources


The Centers for Medicare & Medicaid Services (CMS) is hosting two acknowledgement testing weeks (March 2 -6, 2015 and June 1-5, 2015) for providers and clearinghouses to test with Medicare Administrative Contractors (MACs). Information on how to participate is available on your MAC website or through your clearinghouse. While submitters can submit claims for acknowledgment testing any time prior to the Oct. 1, 2015 implementation date, submitters will have access to real-time help desk support during the testing weeks. Note that acknowledgement testing is not as comprehensive as complete "end-to-end" testing that includes practice receipt of the remittance advice. CMS is expected to open up the July end-to-end testing period to a small number of volunteers in the spring. Read more from CMS on ICD-10 testing. CMS has also released two animated 4-minute videos that explain key ICD-10 concepts. "Introduction to ICD-10 Coding" gives an overview of ICD-10’s features and "ICD-10 Coding and Diabetes" uses diabetes as an example to show how the code set captures important clinical details.

Access MGMA ICD-10 resources.