The Centers for Medicare & Medicaid Services issued a final rule Nov. 27 that updates the payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2014.

The rule changes several of the quality reporting initiatives that are associated with PFS payments, including the Physician Quality Reporting System (PQRS), as well as changes to the Physician Compare tool on the website.

(Making the PQRS work for you and your practice)

The rule also includes the implementation of the Value-Based Payment Modifier (Value Modifier) that affects payment rates to certain groups of 10+ based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional Medicare Fee-for-Service program.

Important 2014 PQRS changes
The rule included several changes for the 2014 PQRS program. Major changes include:

  • Total of 284 measures in 2014.
  • Increase in number of measures reported via claims and registry-based reporting mechanisms from three to nine.
  • Change in reporting threshold for both individuals and groups reporting individual measures via registry to 50% of the eligible professional’s (EP’s) applicable patients (from 80%).
  • Elimination of option to report on claims-based measures groups.

(CMS responds to queries about new measures in ESRD QIP rule)

Payment adjustment updates
In addition, the rule established the following:

  • EPs and group practices that meet the criteria for 2014 PQRS incentive will automatically avoid negative payment adjustment in 2016.
  • EPs using the claims and registry-based reporting mechanisms as well as the newly implemented qualified clinical data registry reporting mechanism may report three measures on 50% of their applicable patients to avoid 2016 PQRS payment adjustments.
  • Elimination of option to report on claims-based measures groups to avoid future payment adjustments.

Group practice reporting changes
For groups who wish to participate using the Group Practice Reporting Option (GPRO) in 2014, the rule included the following changes:

  • Creation of new reporting mechanism, the certified survey vendor reporting mechanism, that allows a group of 25 or more EPs to count reporting of Consumer Assessment of Healthcare Providers and Systems Clinician & Group (CG CAHPS) survey measures towards meeting criteria for satisfactory reporting for the 2014 PQRS incentive and 2016 PQRS payment adjustment.