Medicare Compliance & Reimbursement

CMS wants transition to occur in the next one to three years.

Moving the Medicare program from a fee-for-service payment model to a value- or quality-based structure may seem like a massive undertaking — and it is. But the Centers for Medicare & Medicaid Services (CMS) isn’t shying away from these ambitious goals, nor is it wasting any time in implementing the changes. Here’s CMS’s projected timeline for the Medicare payment transformation:

By the end of 2016, CMS plans to:

• Tie 30 percent of Medicare FFS payments in Part A and Part B to quality or value through alternative payment models (APMs), such as Patient-Centered Medical Homes (PCMHs), Accountable Care Organizations (ACOs), or bundled payment arrangements.
• Link 85 percent of all traditional Medicare payments in Part A and Part B to quality or value through programs such as the Hospital Value Based Purchasing (HVBP) and the Hospital Readmissions Reduction (HRR) Programs.

By the end of 2018, CMS plans to:

• Tie 50 percent of Medicare FFS payments in Part A and Part B to quality or value through APMs such as PCMHs, ACOs, or bundled payment arrangements.
• Tie 90 percent of all traditional Medicare payments in Part A and Part B to quality or value through programs like the HVBP and HRR Programs.