Basis and scope.

(a) Basis. This subpart implements section 1848(p) of the Act by establishing a payment modifier that provides for differential payment starting in 2015 to a group of physicians and starting in 2017 to a group and a solo practitioner under the Medicare Physician Fee Schedule based on the quality of care furnished compared to cost during a performance period. (b) Scope. This subpart sets forth the following: (1) The application of the value-based payment modifier. (2) Performance and payment adjustment periods. (3) Reporting mechanisms for the value-based payment modifier. (4) Alignment of PQRS quality of care measures with the quality measures for the value-based payment modifier. (5) Additional measures for groups and solo practitioners. (6) Cost measures. (7) Attribution for quality of care and cost measures. (8) Scoring methods for the value-based payment modifier. (9) Benchmarks for quality of care measures. (10) Benchmarks for cost measures. (11) Composite scores. (12) Reliability of measures. (13) Payment adjustments. (14) Value-based payment modifier quality-tiering scoring methodology. (15) Limitation of review. (16) Inquiry process. [77 FR 69368, Nov. 16, 2012, as amended at 79 FR 68005, Nov. 13, 2014]