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Figures
- FIGURE.
Overview of the CPT code development process. MPFS indicates Medicare Physician Fee Schedule; QHP, qualified healthcare professionals.
Tables
- Table 1:
Physician payment calculation for a brain MR imaging without dye in the Washington, DC area
Payment Calculation Total RVU = (1.48 × 1.048) + (4.95 × 1.205) + (0.09 × 1.271) Total RVU = 1.55 + 5.96 + 0.11 = 7.62 Payment = 7.62 × $35.8887 Total = $273.47 MIPS AAPM Definition Merit-Based Incentive Payment System Advanced Alternative Payment Model Payment adjustment components Quality (replaces PQRS) Quality measures like MIPS Advancing care information required (eg, use of EMR) Implementing CPIAs is required Otherwise, varies on the basis of APM model (eg, BPCI, Next Generation Accountable Care Organization Model, and so forth) Measures of cost Basic inclusion requirements Fail to meet the 3 requirements to be in an AAPM (see cell to the right) Use of approved EMR Base reimbursement on quality measures like MIPS Required to bear “more than nominal” financial risk Benefits/penalties Upward or downward adjustment of 4%, based on performance measured in 2017 QPs not subject to budget-neutral payment/adjustment Percentage adjustment increases each year, reaching a maximum of ±9% in 2022 Automatic 5% bonus payment based on aggregate Medicare Part B payments during the first 6 years Increase in fee schedule conversion factor used to calculate Medicare Part B payments of 0.25% per year Beginning in 2026, 3-fold increase for QPs in their fee schedule conversion factor used to calculate Medicare Part B payment of 0.75% per year for QPs Effective date (begins impacting physicians' Medicare Part B reimbursements) 2019 2019 Note:—AAPM indicates Advanced Alternate Payment Model; BPCI, Bundled Payments for Care Improvement Initiative; EMR, electronic medical record; CPIA, Clinical Practice Improvement Activities; QP, Qualifying Participant.
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