Part B Insider (Multispecialty) Coding Alert

Published on Fri Sep 06, 2013 PDF

Plus: Even an office manager can face prison time for Medicare fraud.

Voluntary incentive programs are great -- until they fall off your radar and suddenly become required. This will soon be the case for Medicare’s Physician Quality Reporting System (PQRS). If you are in private practice and bill Medicare using an individual-level National Provider Identifier (NPI), you are eligible to participate in PQRS -- and need to get involved ASAP.

PQRS encourages eligible providers to report on their claims when they perform certain quality measures CMS lists for each discipline in each year’s Medicare Physician Fee Schedule. If you report enough quality measures as required by CMS, you receive a bonus of 0.5 percent.

Tables turned: The Affordable Care Act mandated that PQRS move from an incentive program to a “payment adjustment” program in 2015, in which CMS will stop giving bonus payments and, instead, instill a penalty for non-participation.The 2015 deductions will apply to people not participating are going to be based on 2013 participation.

If eligible providers do not successfully report their PQRS measures in the 2013 calendar year, they will see a 1.5 percent payment deduction in 2015. Likewise, if they do not successfully report their PQRS measures in 2014, they will receive a 2 percent deduction in 2016.

To avoid the payment adjustment and to earn the incentive payment, you can submit data through the traditional PQRS methods such as claims, registry and EHR. To avoid the payment adjustment only, CMS says in a Sept. 5 news release, eligible professionals “can request that CMS calculate their quality data from administrative claims.” To participate in this program, you must register by October 15, which is less than a month away.

For more on your options to avoid the pay cut, visit www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/PV-PQRS-EP-Registration-Quick-Guide.pdf.