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Dec 14

The Importance of the Annual Quality and Resource Use Reports

Value-Based Payment Modifier (VM)

We’ve talked a lot about how you report on your performance for a specific year so you can avoid Medicare payment adjustments (i.e., penalties) two years down the road. Well, if you did not report for the incentive programs in 2015, you will feel the pinch from Medicare for the services you provide in 2017, especially if you are a solo practitioner.


The Centers for Medicare and Medicaid Services (CMS) use the Value-Based Payment Modifier (VM) to determine the payment for physicians under the Medicare Physician Fee Schedule (PFS). They determined your payment modifier for 2017 based on the reporting you did (or didn’t do) with the Physician Quality Reporting System (PQRS) program in 2015. Based on that performance in 2015, the VM could decrease the amount you get paid from Medicare.

In previous years, CMS only applied the VM to Medicare payments of groups of eligible professionals (EPs). In payment year 2015, groups of 100 or more EPs felt the pinch, and in payment year 2016, it was groups of 10 or more. And now, in payment year 2017, CMS will now also apply the VM to other groups and solo practitioners. The Quality and Resource Use Report (QRUR) for solo practitioners in previous years was informational only and didn’t affect their payments. This has all changed with the 2015 performance data, and the QRUR outlines the information used to determine the adjustments that will be made to your payments in 2017.

Important Reminder: Review your 2015 Annual QRUR now to prepare for any payment adjustments coming your way in 2017

Your confidential 2015 Quality and Resource Use Report not only outlines your performance for Medicare patients in 2015 and how the performance criteria was used to determine your personal payment modifier, it provides you with comparative data that you can use to improve the care you provide to Medicare beneficiaries in your practice. Using the report, you can see how you compare with other physicians caring for Medicare patients, as well as identify opportunities for improvement within your practice.

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