FEATURE STORY reduction if they have low quality and high cost, or 2 percent if they have low quality and average cost. Likewise, groups with favorable quality-tiering results will be eligible for a 2 or 4 percent payment increase. The VM must be implemented for all physicians by January 1, 2017. But there are some exceptions to the VM program. For example, the program does not apply to payments that are not made under the Medicare PFS, such as those to rural health clinics, federally qualified health centers, and critical access hospitals using method II billing. For 2015 and 2016, the VM does not apply to groups in which any of the group’s physicians participate in any of the following programs: Medicare Shared Savings Program ACOs, Pioneer ACO model, or Comprehensive Primary Care Initiative. Many commercial payors have already implemented quality programs, so it is critical that you understand which programs your clients participate in and which ones are on the horizon. The focus on quality will only increase, so accurate compliance is critical for your clients and your company. Additional Resources There are plenty of resources available on the updates to the PQRS program. Take advantage of all available resources to ensure your success. Here are some examples: • CMS resource on VM: www.cms.gov/Medicare/Medicare-Feefor Service-Payment/PhysicianFeedbackProgram/Downloads/ CY2015ValueModifierPolicies.pdf • CMS resources on PQRS: www.cms.gov/Medicare/Quality- Initiatives-Patient-Assessment-Instruments/PQRS/index.html • MGMA’s PQRS Value Modifier Survival Guide: www.mgma.org/ pqrs-value-modifier-survival-guide • MGMA’s Federal Quality Reporting Program Resource Center: www.mgma.org/qualityresourcecenter Melody W. Mulaik, MSHS, is the president and co-founder of Coding Strategies, Inc. and Coding Metrix, Inc., located in Atlanta, Georgia. She is a frequent speaker and author for CSI and other nationally recognized professional organizations and publications. C U T T I N G - E D G E CLOUD & SERVER-BASED S O F T W A R E f o r H O S P I T A L a n d OFFICE-BASED PHYSICIAN BILLING COMPANIES CPU Medical Management Systems, Inc. offers powerful revenue cycle management software for billing service companies with emphasis on hospital and office-based physicians. Our MED/FM system is designed for office productivity and maximum collection results. CPU has applied 30 years of experience to create a solution that is highly functional and easy to implement. THE JOURNAL OF THE HEALTHCARE BILLING AND MANAGEMENT ASSOCIATION 19 Here’s how we help: • Increased Revenue • Increased Net Collections • Decreased Billing Cost • Improved Billing Workflow Contact us for a no-charge MED/FM demonstration (888) 224-4278 | info@cpumms.com Visit us at booth #208
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