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Can my TIN receive an upward adjustment from the VBM?

Yes, depending on the TIN’s standardized cost and quality composite scores as compared to the national average. The standardized cost and quality scores are displayed as the distance, in standard deviations, from the national average. Depending on how far each score is, in standard deviations, from the national average, either upward, neutral or downward adjustments are given. The maximum upward adjustments also depend on the size of the TIN.

Groups with 2-9 EPs and physician solo practitioners, under quality-tiering in 2017, can receive a maximum upward adjustment of 2.0%.

Groups with 10 of more EPs, under quality-tiering in 2017, can receive a maximum upward adjustment of 4.0%.

Please note that this program is budget neutral, so the upward adjustments are taken from the penalty pull and may not result in the full 2.0% or 4.0% of Medicare claims.

Posted in: Value Based Payment Modifier