QRUR Reports – Key to Success in a Value-Based World

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

VBM Program and QRUR: Impact on Your Revenue and Medicare Reimbursement Rates

On September 18, 2017, CMS released the 2016 Quality and Resource Use Report (QRUR) which explains whether you are eligible to receive a pay cut or increase. The quality and resource use reports (QRUR) provide the results of the statistical analysis used by the value-based modifier (VBM) program and tell a practice what they will be paid. The value-based payment modifier (VBM) program impacts reimbursement for practices of all sizes and specialties, and many managers and physicians in these small and mid-sized practices know little if anything about the program and don’t understand it. The complicated statistical analysis used by the program can feel like a black box to most providers and managers.

Your 2018 Medicare payments will be based on how your practice compares to the national average on cost and quality in 2016. Under the value-based payment modifier (VBM) program, you could receive payment cuts of up to 4% in 2018 – cuts that are in addition to a possible 5% reduction from other Medicare Quality Programs (PQRS – Physician Quality Reporting System and Meaningful Use). Or, if you performed significantly above average, you could receive an increase above the standard Medicare payment rate in 2018.

Join this session with expert speaker Jeanne J. Chamberlin, where she will help you understand the VBM program, how to download your QRUR reports, and how to interpret them. This session will provide the information in a clear language about how to find and use the reports, what they mean, how the VBM will be transitioned into the new merit-based incentive payment system (MIPS) program, and how a practice can use these reports to improve their revenue in the future.

Session Objectives

  • Understand the effect of Pay for Performance – 2017 was the first year when all practices were paid based on the results in the VBM program which continues for the 2018 payment year
  • Understand the impact on your practice of the VBM program being replaced by MIPS starting with 2019 Medicare payments
  • Understand how CMS will compare your practice’s performance on cost and quality in 2016 to a national mean under the VBM program
  • Understand the impact on practices that are outliers – you will see substantial increases or decreases in 2018 Medicare payments  
  • Understand that quality measures used by the VBM program were reported through the PQRS; cost and outcome measures came from Medicare claims data
  • Learn how the QRUR published annually in the fall provide details on how your performance compared to the national average
  • Understand how the QRUR impacts your Medicare reimbursement rate for the following calendar year
  • Learn how to use detailed data included in the QRUR to drill down and identify the drivers of your performance results
  • Understand the impact of the VBM program on payment for 2018
  • Understand the incorporation of many of the measures and concepts of the VBM program into the new MIPS program in future years

Session Highlights

  • Key concepts of the value based modifier (VBM) program and how it impacts 2018 Medicare payments
  • How the VBM relates to PQRS, Meaningful Use and MIPS
  • How to access your quality resource and utilization reports (QRUR)
  • Tips for using the QRUR to make changes in your practice to ensure you receive the maximum possible Medicare reimbursement rates in future years 

Session Agenda

  • Value-based modífier (VBM) quick overview and concepts
  • 2017 VBM results (according to 2015 data), covering how physicians experienced changes in reimbursement rates
  • VBM basics that cover practice-level program, national average comparison, 2-year lag, and data sources
  • VBM changes for large and small practices
  • How a provider can receive maximum penalty automatically if PORS is not reported successfully
  • How many standard deviations is your practice's scoré away from mean, positive or negative value
  • Attribution methodology
  • 2016 data for QRUR reports: average quality, high cost
  • Quality Composite Scoré = PQRS measures + outcome measures (claims)
  • TÍN performance rate calculated for each measure
  • Review outcome measures from claims data
  • Built-up of composite quality scoré
  • The three cost measures to cover costs for services provided (by anyone) to assigned patients
  • How to find QRUR reports and appeal the results
  • QRURs and MIPS

Who Should Attend

  • All specialties – particularly practices with large Medicare populations
  • Practice managers
  • Billing and coding managers
  • Quality management directors and staff
  • Medical directors
  • Physician owners

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About Our Speaker

Jeanne J. Chamberlin

Jeanne J. Chamberlin  is currently a Practice Management Consultant with MSOC Health. Over the past five years, she has worked with dozens of medical practices to improve efficiency and maximize profit.

As practice administrator of a 10-physician multi-specialty practice, Jeanne began reporting quality measures for the PQRS program in 2007. As a consultant with MSOC Health, she has assisted a wide variety of providers...   More Info
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