The Future of Medicare Reimbursement -
The Merit-Based Incentive Payment System
The program is intended to be “budget neutral,” so there will be equal numbers of negative and positive adjustments. Both negative and positive adjustments are capped at 4% in 2019, 5% in 2020, 7% in 2021 and 9% in 2022 and beyond, while positive adjustments must be paid out in an amount equal to the total negative payment adjustments among all providers. Unfortunately, according to CMS’ own estimates, these negative adjustments are likely to disproportionately affect solo practitioners and those in smaller practices, with 86% of solo practices, 69.9% of practices of 2 – 9 eligible clinicians, 59.4% of practices of 10 – 24 clinicians, and 44.9% of practices of 25 – 99 clinicians likely to be penalized, with only 18.3% of practices of 100 or more eligible clinicians likely to be penalized in 2019.
Physicians scoring in the lowest quartile will automatically be adjusted down to the maximum penalty for the performance year. Physicians scoring at the threshold will receive no adjustment. Physicians scoring in the highest quartile are eligible for a potential positive payment adjustments up to the maximum outlined above. The highest performers will receive proportionally larger incentive payments, up to three times the maximum positive adjustment for the year. For years 2019-2024, the law establishes a $500 million bonus pool designed to provide additional incentives of up to 10 percent for “exceptional performers;” however, the law does not provide a definition of “exceptional performer.”
StatLaw® Q&A - The American Health Care Act in the Senate - June 5, 2017
StatLaw® Q&A -Comprehensive Primary Care Plus - May 23, 2017
StatLaw® Q&A - The American Health Care Act - May 9, 2017
StatLaw® Q&A - Improper Prescribing of CDS Not Taken Lightly - May 2, 2017
StatLaw® Q&A - The Ins and Outs of Hospital Rates and How They Affect Healthcare Costs - April 25, 2017
StatLaw® Q&A - CMS Proposes Changes, Improvements Throughout the Medicare Program - April 18 2017
To Avoid Reduction in Medicare Payment in 2019 - You Must Act Quickly In 2017!by: Donald R. Moy - Of Counsel, Esq.
OPMC Reporter - Spring 2017
SBME Reporter - Spring 2017
StatLaw® Q&A - Efforts to Reduce Opioid Addiction are on the Rise - March 28, 2017
StatLaw® Q&A - Justice Department Investigating Large Insurers for Medicare Fraud - March 21, 2017
StatLaw® Q&A - CMS Updates Market Saturation and Utilization Data tool - March 7, 2017
StatLaw® Q&A - President Trump Meets with Insurance Executives to Discuss Affordable Care Act Replacement - February 28, 2017
StatLaw® Q&A - CMS Awards $100 Million for MACRA Training - February 21, 2017
StatLaw® Q&A - CMS Extends Deadline for 2016 Physician Quality Reporting System (PQRS) Electronic Health Record (EHR) Submission - February 7, 2017
StatLaw® Q&A - Aetna-Humana Deal Blocked - January 31, 2017
StatLaw® Q&A - President Trump Signs Executive Order on Affordable Care Act - January 24, 2017
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StatLaw® Q&A - What Will Happen to the Affordable Care Act? - January 10, 2017
OPMC Reporter - Winter 2017
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StatLaw® Q&A - DEA Reverses Announced Change to Registration Renewal Process - December 27,2016
StatLaw® Q&A - DEA Announces New Procedure for Renewal of Registrations - December 20, 2016
StatLaw® Q&A - Trump's Plans for the Affordable Care Act, Medicare and Medicaid Taking Shape - December 6, 2016
StatLaw® Q&A - President Elect Donald Trump Nominates Rep. Tom Price as HHS Secretary - November 29, 2016
StatLaw® Q&A - CMS Launches Quality Payment Program Education Site - November 22, 2016
StatLaw® Q&A - The New Jersey “Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act” - November 8, 2016
StatLaw® Q&A - The Current Pace of Hospital Mergers - November 1, 2016
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