0
Jackie Coult, CHBC
CPT® Disclaimer
2
CPT copyright 2012 American Medical Association. All rights reserved.
Fee schedules, relative value unit...
Overview
3

Physician Quality Reporting System (PQRS) formerly known as the
Physician Quality Reporting Initiative (PQRI) ...
PQRS Payment & Penalty
4

Year
Incentive Payment
2013
2014
Payment Adjustment
2015
2016
2017

Year Data Collected
to Infor...
Incentive Eligibility by Reporting Options
5

Reference: United States Department of Health and Human Services, Centers fo...
PQRS - How To Get Started
6

 STEP 1: Determine if you are eligible to participate or group participate
 STEP 2: Determi...
PQRS - Who’s Eligible?
7

Providers payable under Medicare Physician Fee Schedule
are Eligible to Participate “EP’s” in th...
PQRS Program - Who’s NOT Eligible?
8

Services not payable under Physician Fee Schedules are not
included in Physician Qua...
How to Report PQRS Measures
9
2013 PQRS Reporting Options for Incentive Payment
(Dates of Service 1/1/2013-12/31/2013)
10
Reporting
Mechanism

Group Pra...
NEW 2013 Group Reporting Definition
11

A “group practice” under 2013 Physician Quality
Reporting consists of a physician ...
Factors to Consider
12

At a minimum, EPs should consider the following factors
when selecting measures for reporting:
•Cl...
22 Measures Groups
13
247 Individual Groups
14

Sample of Individual Measures
PQRS
Number

NQF
Number

Measure Title & Description
Diabetes Mell...
Payment Incentives
15

PQRI/PQRS WAS DEVELOPED BY CMS IN 2007
VOLUNTARY PAY-FOR-REPORTING PROGRAM
Reporting Periods
16

There are 2 reporting periods available for eligible
professionals to report 2013 PQRS measures grou...
Claims Reporting
17
Claims-Based Reporting
18

 Claims-based reporting of individual measures on 50% of Medicare

patients (within 12 months ...
Group Measures Reported via Claims & Registry
19

G-codes – intended to report the following Groups:
G8485: Diabetes Mell...
Individual Measures
20

PQRS
Number

Measure Title & Description

Meets
Medical
Performance Performance
Exclusion

Patient...
Measures Reported via Claims
21
Registry Based Reporting
22

Registration Closed
10/18/2013
Registry Based Reporting
23

At least 3 individual PQRS measures for 80% or

more of applicable Medicare Part B FFS patie...
Group Measures Reported via Registry ONLY
24

G-codes – intended to report the following Groups:
 G8544: Coronary Artery ...
Payment Adjustment (Only)
25

EP’S FROM 1-99 CAN AVOID THE -1.5%
PAYMENT A ADJUSTMENT IN 2015
DATE OF SERVICE: JANUARY 1ST...
How to avoid 2015
PQRS Payment Adjustment - Individuals EPs
26

EPs can avoid the 2015 payment adjustment (-1.5%) by
meeti...
How to avoid 2015
PQRS Payment Adjustment - Group
27
Group practices (2-99 EP’s) can avoid 2015 payment adjustments of (-1...
Conclusion
28

Avoid -1.5% Payment Penalty in 2015:
Report on: 1 Medicare PT, 1 Measure, on 1 Claim, 1 time before 12/31/2...
Proposed Changes for 2014 Physician
Quality Programs and The Value Based
Payment Modifier
29
ON JULY 8, 2013, THE CENTERS ...
PQRS – What’s to come in 2014?
30

In an effort to consolidate, CMS will begin to incorporate PQRS Measures into
Meaningfu...
E-Prescribe & Meaningful Use
2013/2014
31

MEANINGFUL USE IS THE SET OF STANDARDS DEFINED BY
THE CENTERS FOR MEDICARE & ME...
Electronic Prescribing Incentive Program
32

For years 2012 through 2014, eligible professionals
who are not successful el...
Meaningful Use Incentive
33
For the most part, EPs may participate in more than one incentive program at the same time. Ho...
Summary of Proposed Stage 2 Rule of Meaningful Use
34

To avoid penalties starting in 2015, EPs need to:
 Attest to mean...
Multiple Incentive Programs at the Same Time
35
Payments Based on the First Year Calendar Year (CY) for Which an EP Receiv...
Need Medicare Assistance
36

Contact the Quality Net Help Desk for help with:
• General CMS PQRS & eRx information
• PQRS ...
Q&A
37
Jackie Coult, CHBC
801-550-5058
Jgc.coult@comcast.net
P.O. Box 171004
Holladay, UT 84117-1004
PQRS - Avoiding the Penalties?
Upcoming SlideShare
Loading in...5
×

PQRS - Avoiding the Penalties?

343

Published on

A discussion with Jackie Coult, CHBC regarding the Physician Quality Reporting System (PQRS) and avoiding potential reimbursement penalties in 2015.

Published in: Health & Medicine, Business
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
343
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
10
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • In accordance with section 1848(m)(3)(C) of the Social Security Act (the Act), CMS created a new group practice reporting option (GPRO) for the Physician Quality Reporting System (PQRS) in 2010. Group practices that satisfactorily report data on PQRS measures for a particular reporting period are eligible to earn a PQRS incentive payment equal to a specified percentage of the group practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the reporting period. 
  • In accordance with section 1848(m)(3)(C) of the Social Security Act (the Act), CMS created a new group practice reporting option (GPRO) for the Physician Quality Reporting System (PQRS) in 2010. Group practices that satisfactorily report data on PQRS measures for a particular reporting period are eligible to earn a PQRS incentive payment equal to a specified percentage of the group practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the reporting period. 
  • In accordance with section 1848(m)(3)(C) of the Social Security Act (the Act), CMS created a new group practice reporting option (GPRO) for the Physician Quality Reporting System (PQRS) in 2010. Group practices that satisfactorily report data on PQRS measures for a particular reporting period are eligible to earn a PQRS incentive payment equal to a specified percentage of the group practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the reporting period. 
  • In accordance with section 1848(m)(3)(C) of the Social Security Act (the Act), CMS created a new group practice reporting option (GPRO) for the Physician Quality Reporting System (PQRS) in 2010. Group practices that satisfactorily report data on PQRS measures for a particular reporting period are eligible to earn a PQRS incentive payment equal to a specified percentage of the group practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the reporting period. 
  • In accordance with section 1848(m)(3)(C) of the Social Security Act (the Act), CMS created a new group practice reporting option (GPRO) for the Physician Quality Reporting System (PQRS) in 2010. Group practices that satisfactorily report data on PQRS measures for a particular reporting period are eligible to earn a PQRS incentive payment equal to a specified percentage of the group practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the reporting period. 
  • In accordance with section 1848(m)(3)(C) of the Social Security Act (the Act), CMS created a new group practice reporting option (GPRO) for the Physician Quality Reporting System (PQRS) in 2010. Group practices that satisfactorily report data on PQRS measures for a particular reporting period are eligible to earn a PQRS incentive payment equal to a specified percentage of the group practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the reporting period. 
  • In accordance with section 1848(m)(3)(C) of the Social Security Act (the Act), CMS created a new group practice reporting option (GPRO) for the Physician Quality Reporting System (PQRS) in 2010. Group practices that satisfactorily report data on PQRS measures for a particular reporting period are eligible to earn a PQRS incentive payment equal to a specified percentage of the group practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the reporting period. 
  • In accordance with section 1848(m)(3)(C) of the Social Security Act (the Act), CMS created a new group practice reporting option (GPRO) for the Physician Quality Reporting System (PQRS) in 2010. Group practices that satisfactorily report data on PQRS measures for a particular reporting period are eligible to earn a PQRS incentive payment equal to a specified percentage of the group practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the reporting period. 
  • Transcript of "PQRS - Avoiding the Penalties?"

    1. 1. Jackie Coult, CHBC
    2. 2. CPT® Disclaimer 2 CPT copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product.
    3. 3. Overview 3 Physician Quality Reporting System (PQRS) formerly known as the Physician Quality Reporting Initiative (PQRI) is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs). Incentive Payment or Penalties are tracked by practices EP’s individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on clinical quality measures (CQM) for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer).
    4. 4. PQRS Payment & Penalty 4 Year Incentive Payment 2013 2014 Payment Adjustment 2015 2016 2017 Year Data Collected to Inform Payment/Penalty Bonus/Adjustment   2013 2014 + 0.5% + 0.5%   2013 2014 2015 - 1.5% - 2.0% - 2.0%
    5. 5. Incentive Eligibility by Reporting Options 5 Reference: United States Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS); 2011 Reporting Experience Including Trends (2008-2012). CMS, 26 Mar. 2013. Web. 11 Apr 2013. (www.cms.gov/pqrs)
    6. 6. PQRS - How To Get Started 6  STEP 1: Determine if you are eligible to participate or group participate  STEP 2: Determine which PQRS reporting method best fits your practice.     Claims-based, or Registry-based, or Qualified Electronic Health Record (EHR), or Group Practice Reporting Option (GPRO)  STEP 3: Review the specific criteria for the chosen reporting option in order to satisfactorily report.  STEP 4: Individual Measures or Measures Group  STEP 5:Review information on the PQRS Payment Adjustment
    7. 7. PQRS - Who’s Eligible? 7 Providers payable under Medicare Physician Fee Schedule are Eligible to Participate “EP’s” in the PQRS program: Medicare Physicians Practitioners Therapists Doctor of Medicine Doctor of Osteopathy Doctor of Podiatric Medicine Doctor of Optometry Doctor of Oral Surgery Doctor of Dental Medicine Doctor of Chiropractic Physician Assistant Nurse Practitioner Clinical Nurse Specialist Certified Registered Nurse Anesthetist (and Anesthesiologist Assistant) Certified Nurse Midwife Clinical Social Worker Clinical Psychologist Registered Dietician Physical Therapist Occupational Therapist Qualified Speech-Language Therapist
    8. 8. PQRS Program - Who’s NOT Eligible? 8 Services not payable under Physician Fee Schedules are not included in Physician Quality Reporting Requirements. •Federally Qualified Health Centers (FQHCs) •Independent Diagnostic Testing Facilities (IDTF) •Independent Laboratories •Hospitals (including critical access hospitals) •Rural Health Clinics •Ambulance Providers •Ambulatory Surgical Centers
    9. 9. How to Report PQRS Measures 9
    10. 10. 2013 PQRS Reporting Options for Incentive Payment (Dates of Service 1/1/2013-12/31/2013) 10 Reporting Mechanism Group Practice Size Registry All Group Practices GPRO Web Interface 25-99 EPs only GPRO Web Interface 100+ EPs only 2013 Registered Group (PQRS GPRO) Reporting Options for Incentive Payment Report at least 3 measures, AND Report each measure for at least 80% of the group practice’s Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0% performance rate will not be counted. Report on all measures included in the Web Interface; AND Populate data fields for the first 218 consecutively ranked and assigned beneficiaries in the order in which they appear in the group’s sample (with an over-sample of 283) for each module or preventive care measure. If the pool of eligible assigned beneficiaries is less than 218, then report on 100% of assigned beneficiaries. Report on all measures included in the Web Interface; AND Populate data fields for the first 411 consecutively ranked and assigned beneficiaries in the order in which they appear in the group’s sample (with an over-sample of 534) for each module or preventive care measure. If the pool of eligible assigned beneficiaries is less than 411, then report on 100% of assigned beneficiaries.  Claims Submission: For the 2015 PQRS payment adjustment only.  Report: 1 Medicare PT, 1 Measure, on 1 Claim, 1 time before 12/31/2013
    11. 11. NEW 2013 Group Reporting Definition 11 A “group practice” under 2013 Physician Quality Reporting consists of a physician group practice, as defined by a single TIN, with 2 or more individual eligible professionals (as identified by individual NPIs) who have reassigned their billing rights to the TIN. This definition of group practice is different from the definition of group practice that was applicable for the 2012 Physician Quality Reporting System, which defined a group practice as 25 or more eligible professionals.
    12. 12. Factors to Consider 12 At a minimum, EPs should consider the following factors when selecting measures for reporting: •Clinical conditions commonly treated •Types of care delivered frequently - e.g., preventive, chronic, acute •Settings where care is often delivered - e.g., office, emergency department (ED), surgical suite
    13. 13. 22 Measures Groups 13
    14. 14. 247 Individual Groups 14 Sample of Individual Measures PQRS Number NQF Number Measure Title & Description Diabetes Mellitus: Hemoglobin A1c Poor Control 1 0059 2 0064 3 0061 *5 *5 0081 0081 Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control Diabetes Mellitus: High Blood Pressure Control Individual Measures Reporting: Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Measures Group Reporting: Heart Failure: Angiotensin- Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
    15. 15. Payment Incentives 15 PQRI/PQRS WAS DEVELOPED BY CMS IN 2007 VOLUNTARY PAY-FOR-REPORTING PROGRAM
    16. 16. Reporting Periods 16 There are 2 reporting periods available for eligible professionals to report 2013 PQRS measures groups: 12- month reporting period from January 1 through December 31, 2013, OR a 6-month reporting period from July 1 through December 31, 2013 (available only via Registry). Registry Closed on October 18th, 2013.  The 6-month reporting period allows those eligible professionals who may have decided to participate later in the year to begin reporting.
    17. 17. Claims Reporting 17
    18. 18. Claims-Based Reporting 18  Claims-based reporting of individual measures on 50% of Medicare patients (within 12 months period)  138 individual quality measures eligible for claims-based reporting  Claims-based reporting of at least one measures group for 20 unique Medicare Part B FFS patients (12 months)  12 measures groups eligible for claims-based reporting  Measures groups containing a measure with a 0% performance rate will not be counted as satisfactorily reporting the measures group.  EPs may choose to submit Quality Data Codes (QDC) either on a current claim or on a claim representing a subsequent visit, particularly if the quality action has changed. For example, a new laboratory value may be available at a subsequent visit.
    19. 19. Group Measures Reported via Claims & Registry 19 G-codes – intended to report the following Groups: G8485: Diabetes Mellitus (DM) Measures Group G8487: Chronic Kidney Disease (CKD) Measures Group G8486: Preventive Care Measures Group G8490: Rheumatoid Arthritis Measures Group G8492: Perioperative Care Measures Group G8493: Back Pain Measures Group G8545: Hepatitis C Measures Group G8547: Ischemic Vascular Disease (IVD) Measures Group G8645: Asthma Measures Group G8898: Chronic Obstructive Pulmonary Disease (COPD) Measures Group G8902: Dementia Measures Group G8905: Cardiovascular Prevention Measures Group
    20. 20. Individual Measures 20 PQRS Number Measure Title & Description Meets Medical Performance Performance Exclusion Patient Performance Exclusion System Other Performance Performance Performance Not Met Exclusion Exclusion Perioperative Care: Meets all measures 20, 21, 22, 23 G8510 Perioperative Care: Timing of Prophylactic Parenteral Antibiotic – Ordering Physician Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin G8629 G8630 N/A N/A N/A G8631 No Report G8632 4041F 4041F-1P N/A N/A No Report 4041F-8P Perioperative Care: Discontinuation of Prophylactic Parenteral Antibiotics (Non- Cardiac Procedures) 4049F & 4046F 4049F-1P & 4046F N/A N/A 22 4042F No Report 4049F-8P & 4046F 4044F 4044F-1P N/A N/A No Report 4044F-8P 23 Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) 5015F-1P 5015F-2P N/A No Report 5015F-8P 24 Osteoporosis: Communication with the 5015F Physician Managing On-going Care Post-Fracture of Hip, Spine or Distal Radius for Men and Women Aged 50 Years and Older 20 21
    21. 21. Measures Reported via Claims 21
    22. 22. Registry Based Reporting 22 Registration Closed 10/18/2013
    23. 23. Registry Based Reporting 23 At least 3 individual PQRS measures for 80% or more of applicable Medicare Part B FFS patients of each eligible professional (12 months) At least one measures group for 20 patients, the majority of which must be Medicare Part B FFS patients (12 months) At least one measures group for 20 patients, the majority of which must be Medicare Part B FFS patients (6 months)
    24. 24. Group Measures Reported via Registry ONLY 24 G-codes – intended to report the following Groups:  G8544: Coronary Artery Bypass Graft (CABG) Measures Group G8548: Heart Failure (HF) Measures Group G8489: Coronary Artery Disease (CAD) Measures Group G8491: HIV/AIDS Measures Group G8899: Inflammatory Bowel Disease (IBD) Measures Group G8900: Sleep Apnea Measures Group  G8903: Parkinson’s Disease Measures Group  G8904: Hypertension (HTN) Measures Group  G8906: Cataracts Measures Group  G8977: Oncology Measures Group
    25. 25. Payment Adjustment (Only) 25 EP’S FROM 1-99 CAN AVOID THE -1.5% PAYMENT A ADJUSTMENT IN 2015 DATE OF SERVICE: JANUARY 1ST-DECEMBER 31ST, 2013 CLAIM MUST PROCESS BY: FEBRUARY 28TH, 2014
    26. 26. How to avoid 2015 PQRS Payment Adjustment - Individuals EPs 26 EPs can avoid the 2015 payment adjustment (-1.5%) by meeting one of the following criteria during the 2013 PQRS program year: 1.EP reports at least: 1. 2. One valid individual measure via claims, or through a qualified Electronic Health Record (EHR), OR One valid group measure via claims
    27. 27. How to avoid 2015 PQRS Payment Adjustment - Group 27 Group practices (2-99 EP’s) can avoid 2015 payment adjustments of (-1.5%) by meeting one of the following criteria during the 2013 PQRS program year. NOTE: If you have NOT registered through the registry, GPRO or PV-PQRS (closed October 18, 2013), see option 4: 1.Group meets the following requirements, outlined in the 2013 PQRS measure specification for satisfactorily reporting:  Reports specific ACO/GPRO measures through the Web Interface based on a pre-populated patient sample (only available to group practices of 25 or more EPs) OR  Reports at least 3 registry measures (for 80% of the group’s eligible patients for each measure) for the GPRO outlined in the 2013 PQRS Measure Specification for Claims/Registry Reporting of Individual Measures (available to all group practices of 2 or more EPs) Group reports at least one valid measure through: 1. 2. Web Interface (only available to group practices of 25 or more EPs) OR Participating Registry (available to all GPRO participants) a)Group elects to participate as a GPRO in the administrative claims-based reporting mechanism by October 18, 2013. b)EP reports at least:   One valid individual measure via claims, or through a qualified Electronic Health Record (EHR), OR One valid group measure via claims
    28. 28. Conclusion 28 Avoid -1.5% Payment Penalty in 2015: Report on: 1 Medicare PT, 1 Measure, on 1 Claim, 1 time before 12/31/2013. Note: Claim must be processed by no later than 2/28/2014 Obtain +.5% Incentive Payment in 2013: Report on: 50% Medicare PT’s, 1-3 Measures, on all Claims or reporting option selected (the applicable 50%), for 6 months, before 12/31/2013. Although, CMS proposal for PQRS in 2014, to avoid 2% Penalty in 2016 is: Report on: 50% Medicare PT, 3 Measures, on all Claims, for 1 yr.
    29. 29. Proposed Changes for 2014 Physician Quality Programs and The Value Based Payment Modifier 29 ON JULY 8, 2013, THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) ISSUED A PROPOSED RULE THAT WOULD UPDATE PAYMENT POLICIES AND PAYMENT RATES FOR SERVICES FURNISHED UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE (MPFS) ON OR AFTER JAN. 1, 2014. THE PROPOSED RULE ALSO PROPOSES CHANGES TO SEVERAL OF THE QUALITY REPORTING INITIATIVES THAT ARE ASSOCIATED WITH PFS PAYMENTS, INCLUDING THE PHYSICIAN QUALITY REPORTING SYSTEM (PQRS), AS WELL AS CHANGES TO THE PHYSICIAN COMPARE TOOL ON THE MEDICARE.GOV WEBSITE. FINALLY, THE PROPOSED RULE INCLUDES PROPOSALS FOR IMPLEMENTING THE VALUEBASED PAYMENT MODIFIER (VALUE MODIFIER) REQUIRED BY THE AFFORDABLE CARE ACT THAT WOULD AFFECT PAYMENT RATES TO CERTAIN GROUPS BASED ON THE QUALITY AND COST OF CARE THEY FURNISH TO BENEFICIARIES ENROLLED IN THE TRADITIONAL MEDICARE FEE-FOR-SERVICE PROGRAM.
    30. 30. PQRS – What’s to come in 2014? 30 In an effort to consolidate, CMS will begin to incorporate PQRS Measures into Meaningful Use Stage 2 by reducing claims-based reporting. Add and Delete Measures  47 new individual Measures  3 Measure groups  Retire a number of claims-based measures (encourage reporting via registry & EHR-based mechanisms) Individual EPs  Increase the number of measures that must be reported from 3-9 (for both claims & registry)  Reduce a reporting threshold via registry from 80% to 50% for all applicable patients on individual measures  Eliminate the reporting option to report on claims-based measure groups PQRS reporting utilizing the Clinical Data Registries  Report at least 9 measures to the registry covering 3 of the National Quality Strategy domains  Report at least 50% of the applicable patients Individual EPs
    31. 31. E-Prescribe & Meaningful Use 2013/2014 31 MEANINGFUL USE IS THE SET OF STANDARDS DEFINED BY THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) INCENTIVE PROGRAMS THAT GOVERNS THE USE OF ELECTRONIC HEALTH RECORDS AND ALLOWS ELIGIBLE PROVIDERS AND HOSPITALS TO EARN INCENTIVE PAYMENTS BY MEETING SPECIFIC CRITERIA.
    32. 32. Electronic Prescribing Incentive Program 32 For years 2012 through 2014, eligible professionals who are not successful electronic prescribers will receive a payment adjustment under the eRx Incentive Program are as follows: Utilizing e-Prescribing Not Utilizing e-Prescribing +1.0% in 2012 +0.5% in 2013 -1.0 % in 2012 -1.5 % in 2013 -2.0 % in 2014
    33. 33. Meaningful Use Incentive 33 For the most part, EPs may participate in more than one incentive program at the same time. However, there are some limitations. This table outlines the programs that EPs may participate in at the same time: Table 1: Maximum EHR Incentive Payments by Program Based on the First Calendar Year (CY) for Which the EP Receives Payment CY CY 2011 Medicare Medicaid 2011 $18,000 Medicare Medicaid $12,000 $8,500 $18,000 2013 $8,500 $12,000 2014 $4,000 $8,500 2015 $2,000 Medicaid $8,500 $15,000 $8,000 $8,500 $12,000 $8,500 $4,000 $8,500 $2,000 $8,500 CY 2015 CY 2016 Medicare Medicaid Medicare Medicaid $21,250 $8,500 Medicaid $8,500 $12,000 $21,250 $8,000 $8,500 $8,000 $8,500 $21,250 $4,000 $8,500 $4,000 $8,500 $8,500 $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 2017 Medicare $8,500 2016 Medicare CY 2014 $21,250 $8,000 CY 2013 $21,250 2012 CY 2012 $8,500 $8,500 2018 2019 2020 2021 $8,500 Total (if EP does not switch programs) $44,000 $63,750 $44,000 $63,750 $39,000 $63,750 $24,000 $63,750 $0 $63,750 $0 $63,750 NOTE: Medicare EPs may not receive EHR incentive payments under both Medicare and Medicaid. NOTE: The amount of the annual EHR incentive payment limit for each payment year will be increased by 10 percent for EPs who predominantly furnish services in an area that is designated as an HPSA.
    34. 34. Summary of Proposed Stage 2 Rule of Meaningful Use 34 To avoid penalties starting in 2015, EPs need to:  Attest to meaningful use in 2013; or  Have achieved and attested to the first year of meaningful use by October 1, 2014 The requirement as to when different stages of meaningful use need to be met was officially relaxed.  Those that attest to meaningful use in 2011 must meet Stage 2 criteria in 2014 and Stage 3 in 2016 Quality measures are still not final. The proposed rule generally makes Stage 1 optional (menu) items required (core) in Stage 2
    35. 35. Multiple Incentive Programs at the Same Time 35 Payments Based on the First Year Calendar Year (CY) for Which an EP Receives an EHR Incentive Payment* This table identifies the maximum incentive payments available by year depending on whether the EP chooses to participate in either the Medicare or Medicaid EHR Incentive Program. It also shows payment adjustments for not meeting these criteria.
    36. 36. Need Medicare Assistance 36 Contact the Quality Net Help Desk for help with: • General CMS PQRS & eRx information • PQRS Portal password issues • PQRS/eRx feedback report availability and access • PQRS-IACS registration questions • PQRS-IACS login issues PQRS Registry website: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Registry-Reporting.html PQRS EHR: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Electronic-Health-Record-Reporting.html PQRS GPRO website: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Group_Practice_Reporting_Option.html Monday – Friday; 7:00 a.m.–7:00 p.m. CST Phone: 1-866-288-8912 TTY: 1-877-715-6222 Email: qnetsupport@sdps.org
    37. 37. Q&A 37
    38. 38. Jackie Coult, CHBC 801-550-5058 Jgc.coult@comcast.net P.O. Box 171004 Holladay, UT 84117-1004
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×