Federal
Basis and scope.
42 CFR § 414.1200
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19 segments
42 CFR § 414.1200
42 CFR § 414.1200
Basis and scope.
(a)
Basis. This subpart implements section 1848(p) of the Act by establishing a payment modifier that provides for differential payment starting in 2015 to a group of physicians and starting in 2017 to a group and a solo practitioner under the Medicare Physician Fee Schedule based on the quality of care furnished compared to cost during a performance period.
(b)
Scope. This subpart sets forth the following:
(1)
The application of the value-based payment modifier.
(2)
Performance and payment adjustment periods.
(3)
Reporting mechanisms for the value-based payment modifier.
(4)
Alignment of PQRS quality of care measures with the quality measures for the value-based payment modifier.
(5)
Additional measures for groups and solo practitioners.
(6)
Cost measures.
(7)
Attribution for quality of care and cost measures.
(8)
Scoring methods for the value-based payment modifier.
(9)
Benchmarks for quality of care measures.
(10)
Benchmarks for cost measures.
(11)
Composite scores.
(12)
Reliability of measures.
(13)
Payment adjustments.
(14)
Value-based payment modifier quality-tiering scoring methodology.
(15)
Limitation of review.
(16)
Inquiry process.
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