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Payment Adjustments

Value-Based Payment Modifier Program

The Value-Based Payment Modifier program automatically analyzes quality and cost measures based on claims-based data and submitted PQRS measures. Eligible Professionals (EP) do not have to report anything additionally for this program. Since the value modifier program is a budget-neutral program, total upward and downward adjustments will be balanced so the average change is 0 percent. Providers who perform exceptionally well and above the national average can receive positive payment adjustments.
Solo providers, or EPs in groups of 2 to 9 can receive a 2 percent positive or negative payment adjustment, or a neutral payment adjustment in addition to the PQRS penalty. Eligible professionals in groups of 10 or more providers can receive 4 percent positive or negative payment adjustment, or a neutral payment adjustment in addition to the PQRS penalty. These payment adjustments will be applied to all Medicare Part B Claims in 2018.
Providers who do not satisfactorily report data on quality measures in the 2016 performance year will receive an automatic -2 percent payment adjustment to their 2018 Medicare Part B claims.

Step-by-step Action Plan

Action Plan:

Our action plan is made to avoid payment adjustments. Before you begin, determine which providers in your practice are eligible for PQRS.

Step 1

Register with NJII to begin your reporting process. Your practice contacts will receive login credentials to the NJII PQRS Registry.

Step 2

For each provider, select your reporting option. For guidance in selecting measures related to your specialty, visit Measures by Specialty.

Step 3

Collect the required patient information from your practice’s medical records.

Step 4

Report your PQRS data to NJII.

Step 5

Confirm your PQRS data by March 2017.

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