Current through September 30, 2024
Section 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.(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.(12) Reliability of measures.(13) Payment adjustments.(14) Value-based payment modifier quality-tiering scoring methodology.(15) Limitation of review.77 FR 69368, Nov. 16, 2012, as amended at 79 FR 68005, Nov. 13, 2014