SOURCE: LogixHealth

LogixHealth

March 15, 2016 10:00 ET

LogixHealth Analyzes the CMS 2016 Value Modifier Results and Upward Payment Adjustment Factor

BEDFORD, MA--(Marketwired - Mar 15, 2016) - LogixHealth, a leading provider of internet and software enabled coding, billing, analytics and management services for hospital and physician practices nationwide, provides services for millions of Emergency Department, hospital-based and office visits across 35 states, and has analyzed the 2016 Value Modifier Results and Upward Payment Adjustment Factor.

The Affordable Care Act mandated a gradual phase in of a value based payment modifier, which would provide upward or downward adjustments to physician payments based upon an individual provider's cost and quality scoring. Providers in 2016 are now experiencing payment adjustments that are based upon the quality and cost scores for services provided during 2014. CMS has now released the first results from the 2016 value based modifier program, which is the driver of the payment adjustments that physicians are currently experiencing.

There are 13,813 physician group practices with 10 or more eligible professionals that are subject to the 2016 value modifier. 128 groups exceeded the program's benchmarks in quality and cost efficiency and are seeing an increase in their payments. Physicians in 59 groups are experiencing a decrease in their 2016 Medicare payments due to a downward adjustment related to the value-based modifier. Importantly, physicians in 5,418 groups failed to meet the minimum reporting requirements and are seeing a decrease in their 2016 Medicare payments.

"The implementation of meaningful monetary penalties underscores the importance of adequately reporting the required quality measures under PQRS" states Michael Granovsky President of LogixHealth, adding "and the amount of reimbursement at risk is scheduled to increase significantly over the next several years".

Medicare payments for most physician groups nationwide (8,208 groups) that met the minimum reporting requirements remain unchanged in 2016 because of their successful reporting and performance on quality and cost efficiency measures.

A very small number of groups significantly exceeded the minimum requirements and qualified for a substantial 2016 upward payment adjustment based upon having the highest quality scores; their 2016 upward payment adjustment factor is +15.92%

About LogixHealth:
LogixHealth, a leading provider of internet and software enabled coding, billing, analytics and management services for hospital and physician practices nationwide, provides services for millions of Emergency Department, hospital-based and office visits across over 35 states. We provide tools and resources to optimize financial performance and improve the quality of care. For more information, visit www.logixhealth.com.

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