§414.1200. Basis and scope.
42 C.F.R. § 414.1200
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.
Scope. This subpart sets forth the following:
The application of the value-based payment modifier.
Performance and payment adjustment periods.
Reporting mechanisms for the value-based payment modifier.
Alignment of PQRS quality of care measures with the quality measures for the value-based payment modifier.
Additional measures for groups and solo practitioners.
Cost measures.
Attribution for quality of care and cost measures.
Scoring methods for the value-based payment modifier.
Benchmarks for quality of care measures.
Benchmarks for cost measures.
Composite scores.
Reliability of measures.
Payment adjustments.
Value-based payment modifier quality-tiering scoring methodology.
Limitation of review.
Inquiry process.
Notes, amendments, and revision history
Amendments
[77 FR 69368, Nov. 16, 2012, as amended at 79 FR 68005, Nov. 13, 2014]
Source
Source: 77 FR 69368, Nov. 16, 2012, unless otherwise noted.
Authority
Authority: 42 U.S.C. 1302, 1395hh, and 1395rr(b)(l).
Source
Source: 55 FR 23441, June 8, 1990, unless otherwise noted.
Amendments
[77 FR 69368, Nov. 16, 2012, as amended at 79 FR 68005, Nov. 13, 2014]