Value Based Modifier (VBM)

The VPM provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (MPFS) based upon the quality of care furnished compared to the cost of care during a performance period. It is an adjustment made to payments for items and services under the MPFS.

The VBM program can cause an adjustment to payments issued to providers. For 2017-2018, the adjustment is 2% for groups of 2-9 providers and 4% for groups of 10 or more providers.

  • Adjustment is made on a per claim basis
  • It is applied only to assigned claims for procedures that have a MPFS allowed amount
  • It is applied to paid amount after deductible is taken; it is not applied to allowed/fee schedule amount
  • It is applied at Taxpayer Identification Number (TIN) level
    • If billing Provider Transaction Access Number (PTAN) has a TIN that matches a VBM record, claim can be subject to payment adjustment
  • Payment adjustments can be either positive, negative, or neutral
    • This means it can increase, decrease, or have no monetary impact on a claim at all

Direct questions regarding the VBM adjustments to the Physician Value Help Desk at 1-888-734-6433, Option 3.

Resources

 

Last Updated Fri, 14 Feb 2020 12:18:28 +0000