2013 Incentive National Handout from CMS
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

2013 Incentive National Handout from CMS

on

  • 2,751 views

 

Statistics

Views

Total Views
2,751
Views on SlideShare
1,297
Embed Views
1,454

Actions

Likes
0
Downloads
2
Comments
0

4 Embeds 1,454

http://www.managemypractice.com 1136
http://managemypractice.com 316
https://www.google.com 1
http://webcache.googleusercontent.com 1

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

2013 Incentive National Handout from CMS Presentation Transcript

  • 1. Provider Deadlines forCMS Programs 2013
  • 2. Introduction• Focus on three programs specifically: Physician Quality Reporting System(PQRS), e-prescribing (eRx), and the Electronic Health Records (EHR)meaningful use incentive program• Today’s aim: show how decision to participate in one or more programs couldaffect incentive payments or payment adjustments to Medicare reimbursement– Aligns with new CMS e-Health initiative at http://www.cms.gov/ehealth/• 2013 is a critical year for Medicare eligible professionals for these three programs– CMS adopted the concept of a “two-year look back period” for payment adjustments• Topics covered: eligibility, important 2013 deadlines, and decision trees for eachprogram2
  • 3. EligibilityPQRS eRx EHR Incentive ProgramEligible forIncentiveSubject toPaymentAdjustmentEligible forIncentive(1)Subject toPaymentAdjustment(2)Eligible forMedicareIncentive(3)Eligible forMedicaidIncentive(4,5)Subject to MedicarePaymentAdjustment (7,8)Medicare PhysiciansDoctor of Medicine X X X X X X XDoctor of Osteopathy X X X X X X XDoctor of Podiatric Medicine X X X X X XDoctor of Optometry X X X X XDoctor of Oral Surgery X X X X X XDoctor of Dental Medicine X X X X X XDoctor of Chiropractic X X X X XPractitionersPhysician Assistant X X X X X (6)Nurse Practitioner X X X X XClinical Nurse Specialist (9) X X XCertified Registered NurseAnesthetist (10) X X XCertified Nurse Midwife X X X XClinical Social Worker X X XClinical Psychologist X X XRegistered Dietician X X XNutrition Professional X X XAudiologists X X XTherapistsPhysical Therapist X X XOccupational Therapist X X XQualified Speech-LanguageTherapist X X XWho is Eligible for Which Programs?3
  • 4. Eligibility Footnotes1. (eRx) Eligibility defined by Section 1848 (k) (3) of the Social Security Act;professionals must also have prescribing authority2. (eRx) Automatically exempt from eRx payment adjustment if provider didnot have at least 100 cases with encounter code in measure’sdenominator or did not have at least 10% of Medicare Part B allowedcharges for encounter codes in measure’s denominator• Also could have submitted G8642 (rural area); G8643 (insufficientpharmacies); or G8644 (no prescribing privileges)4
  • 5. 3. (EHR) Eligible Professionals (EPs) are considered hospital-based (and thereforeineligible to participate as an individual) if 90% or more of services took place in POS21 (inpatient) or POS 23 (emergency department)4. (EHR) Medicare EPs may not receive EHR incentive payments under both Medicare andMedicaid5. (EHR) To be eligible for the Medicaid incentive program EP must have a minimum 30%Medicaid patient volume (minimum 20% if a pediatrician), or practice predominantly in afederally qualified health center (FQHC) or rural health center (RHC) with a minimum 30%patient volume attributable to needy individuals6. (EHR) Physician assistants (PA) are eligible for the Medicaid EHR incentive program ifthey furnish services in an FQHC or RHC that is led by a PA7. (EHR) If a provider is eligible for the Medicaid EHR incentive program but has Medicarereimbursement, could be subject to Medicare payment adjustment if criteria are not met8. (EHR) Per Stage 2 Final rule, doctors with the designation of radiology, pathology, oranesthesiology are automatically exempt from the EHR payment adjustment9. Includes Advanced Practice Registered Nurse (APRN)10. Also applies to Anesthesiologist AssistantEligibility Footnotes, cont.5
  • 6. Eligible But Not Able toParticipate (PQRS/eRx)• Professionals paid under or based upon the physician feeschedule (PFS) Medicare Carriers/Medicare AdministrativeContractors (MACs) who do not bill directly• Professionals paid under the PFS billing Medicare fiscalintermediaries (FIs) or MACs (Part A)• The FI/MAC claims processing systems currently cannotaccommodate billing at the individual physician orpractitioner level6
  • 7. Eligible But Not Able toParticipate (PQRS/eRx), cont.• Critical access hospital (CAH) method II payment, where thephysician or practitioner has reassigned his or her benefits to theCAH– CAH bills FI/MAC for professional services• All institutional providers that bill for outpatient therapy provided byphysical and occupational therapists and speech languagepathologists• Services payable under fee schedules or methodologies other thanPFS are not included7
  • 8. 2013 Milestone DatesDate Program MilestoneMarch 29,2013PQRS • Maintenance of Certification (MOC) vendors 2012 datasubmission deadline• http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/Fully-Qualified-2012-MOC-Posting-Document-Rev-11282012.pdfMarch 31,2013PQRS • Deadline for 2012 PQRS Data Submission:- Registry Vendors• Group practice reporting option (GPRO) submission of 2012Web-interface data (by end of first quarter of 2013)eRx • eRx Incentive Program Submission:- Registry Vendors8
  • 9. 2013 Milestone DatesDate Program MilestoneJune 30,2013eRx • End of 6-month reporting period that coincides with the 2013eRx incentive reporting period to avoid the 2014 eRx paymentadjustment(see slide 10)eRx • Last day to apply for 2014 eRx Hardship Exemption(see slides 11 & 12)July 26,2013eRx • Deadline for claims to be processed into the National ClaimsHistory (NCH)Fall 2013(TBD)eRx • Deadline for EPs to submit an email request for an informalreview of 2012 eRx incentive payment due no later than 90days from receipt of eRx feedback report9
  • 10. eRx Payment Adjustmentsfor 2014 (-2.0% of MFPS)ReportingPeriodIndividual EPs 2-24 EPs(new in2013)25-99 EPs 100+ EPs6 month(ClaimsONLY)Report the eRxmeasure’snumerator code atleast 10 timesbetween January 1,2013 and June 30,2013Report theeRxmeasure’snumeratorcode at least75 timesbetweenJanuary 1,2013 andJune 30,2013Report the eRxmeasure’snumerator code atleast 625 timesbetween January1, 2013 and June30, 2013Report the eRxmeasure’snumerator code atleast 2500 timesbetween January 1,2013 and June 30,201310
  • 11. Significant Hardship Exemption Category Method ofSubmissionDeadlinefor 2014ExemptionThe eligible professional or group practice practices in a ruralarea with limited high speed internet accessWeb-basedCommunicationSupport PageJune 30,2013The eligible professional or group practice practices in anarea with limited available pharmacies for electronicprescribingWeb-basedCommunicationSupport PageJune 30,2013The eligible professional or group practice is unable toelectronically prescribe due to local, state, or Federal law orregulationWeb-basedCommunicationSupport PageJune 30,2013eRx Hardship Exemptions11
  • 12. Significant Hardship Exemption Category Method ofSubmissionDeadlinefor 2014ExemptionThe eligible professional or group practice has limitedprescribing activity, as defined by an eligible professionalgenerating fewer than 100 prescriptions during a 6-monthreporting periodWeb-basedCommunicationSupport PageJune 30,20132014 Adjustment: Eligible professionals or group practiceswho achieve meaningful use during the 2014 12- and 6-month eRx payment adjustment reporting periods (that is,January 1, 2012 – June 30, 2013)EHR IncentiveProgram’sRegistration/Attestation PageJune 30,2013Eligible professionals or group practices whodemonstrate intent to participate in the EHR IncentiveProgram and adoption of Certified EHR TechnologyEHR IncentiveProgram’sRegistration/Attestation PageJune 30,2013eRx Hardship Exemptions12
  • 13. 2013 Milestone DatesDate Program MilestoneOctober 3,2013Medicare EHRIncentive Program• Last day for EPs to begin 90-day reporting period for 2013(first year of participation)October 15,2013PQRS • Last day to elect Administrative Claims option to avoid the2015 payment adjustment• A reporting mechanism under which an EP or grouppractice elects to have CMS analyze claims data todetermine which measures an EP or group practicereports• Deadline for group practices to submit a self-nominationstatement via a CMS-developed website• Group practices consisting of 100+ EPs, beginning in2015, will be subject to the Value Based Modifier basedon PQRS reporting in 2013• Deadline for groups consisting of 100+ EPs to elect quality-tiering approach to VBMDecember31, 2013Medicare EHRIncentive Program,PQRS, eRx• Participation year ends for all programs• End of period to avoid 2015 PQRS payment adjustment13
  • 14. Did you report the eRx measure’s numeratorcode at least 25 times in 2012?Yes No2013 eRx Decision TreeGroup 25-99: 625 timesGroup 100+: 2500 times14
  • 15. You will avoid the 2014eRx payment adjustmentDid you successfully attest to meaningful use ofcertified EHR technology in 2012 (Medicare)?You may be eligible toearn a 1.0% 2012 eRxincentive payment(paid in 2013)YesYou cannot earn aneRx incentive in thesame year in whichyou earn a Medicaremeaningful useincentiveQ: Did you report the eRx measure’s numerator code at least 25times in 2012?A: YesNo2013 eRx Tree, cont.15
  • 16. Do you expect to report the eRx measure’s numeratorcode at least 10 times by 6/30/13?*You will avoid the 2014 eRxpayment adjustmentYou will be subject toa 2.0% eRx paymentadjustment toMedicare Part Breimbursement in2014Do you plan to demonstrate meaningfuluse of certified EHR technology in 2013(Medicare)?Do you qualify for a hardship exemption forthe 2014 eRx payment adjustment(see slides 11 & 12)?You cannot earn an eRxincentive in the sameyear in which you earn aMedicare meaningfuluse incentiveDo you expect to reportthe eRx measure’snumerator code at least25 times by 12/31/13?*You may earn 0.5% eRx incentivepayment for 2013 (paid in 2014)You will not earn an eRx incentiveYou will avoid the 2014eRx payment adjustmentif you apply for anexemption by 6/30/13Yes NoQ: Did you report the eRx measure’s numerator code at least 25times in 2012?A: NoNoYesYes NoNoYes2013 eRx Tree, cont.Group 2-24: at least 75 timesGroup 25-99: at least 625 timesGroup 100+: at least 2500 times16
  • 17. 2013 Medicare HITECHMeaningful Use Decision TreeHave you attested to meaningful use ofcertified EHR technology prior to 2013?Yes No17
  • 18. Do you plan to demonstrate meaningful use of certifiedEHR technology in 2013?You will avoid the 2015meaningful use paymentadjustmentIn what year did you firstdemonstrate meaningful use?1st Yearof MU2013 Incentive Amount2011 $8,0002012 $12,000Do you expect to be subject to 2014eRx payment adjustment?You will be subject toa meaningful usepayment adjustmentof 2.0% in 2015You will be subject toa meaningful usepayment adjustmentof 1.0% in 2015Q: Have you attested to meaningful use of certified EHR technologyprior to 2013?A: YesYes NoYes No2013 Medicare HITECH Tree,cont.18
  • 19. Do you plan to demonstrate meaningful use of certifiedEHR technology in 2013?You may earn a MU incentive of$15,000 and avoid 2015 MUpayment adjustment (90-dayreporting period)Do you plan to demonstratemeaningful use of certified EHRtechnology by 10/1/14?You may earn $12,000 incentive in 2014and avoid the 2015 & 2016 MU paymentadjustment if you start by 7/1/14Do you qualify for a hardshipexemption for the 2015 paymentadjustment for MU? (see next slide)?You will avoid the 2015 MUpayment adjustment if you applyfor an exemption by 6/30/14Do you expect to be subject to2014 eRx paymentadjustment?NO: You will be subjectto a meaningful usepayment adjustment of1.0% in 2015Q: Have you attested to meaningful use of certified EHRtechnology prior to 2013?A: NoYesYES: You will be subject to ameaningful use paymentadjustment of 2.0% in 2015NoYes NoYes No2013 Medicare HITECH Tree, cont.19
  • 20. Hardship Exemptions forMedicare EPs to Avoid PaymentAdjustment for MU(1) Infrastructure — EPs must demonstrate that they are in an area without sufficientinternet access or face insurmountable barriers to obtaining infrastructure (e.g., lack ofbroadband).(2) New EPs — Newly practicing EPs who would not have had time to become meaningfulusers can apply for a 2-year limited exception to payment adjustments. Thus EPs whobegin practice in calendar year 2015 would receive an exception to the penalties in 2015and 2016, but would have to begin demonstrating meaningful use in calendar year 2016to avoid payment adjustments in 2017.(3) Unforeseen Circumstances — Examples may include a natural disaster or otherunforeseeable barrier.(4) Patient Interaction:a) Lack of face-to-face or telemedicine interaction with patientsb) Lack of follow-up need with patients(5) Practice at Multiple Locations: Lack of control over availability of CEHRT formore than 50% of patient encounters2020
  • 21. 2013 Medicaid HITECHMeaningful Use Decision TreeDo you also have Medicare reimbursement?Yes No21
  • 22. NoYou may earn$21,250incentive in 2013Q: Do you also have Medicarereimbursement?NO: You will not be subjectto MU paymentadjustments; you may earna maximum of $63,750through 2021YES: Have you adopted/implemented/orupgraded (A/I/U) certified EHR technologyprior to 2013?You may earn an$8,500 MUincentive andavoid 2015Medicare MUpaymentadjustmentDo you plan to demonstratemeaningful use of certifiedEHR technology in 2013?See nextslideDo you intend to A/I/U certifiedEHR technology in 2013?See nextslideDo you plan todemonstratemeaningful use ofcertified EHRtechnology in2013?*YES: You may earn$21,250 MUincentive in 2013and avoid 2015Medicare MUpayment adjustmentNO: Seenextslide* Possible to doMU withouthaving doneA/I/U previouslyYesNoYesYesNo2013 Medicaid HITECHMeaningful Use Decision Tree22
  • 23. If you have not attested to meaningful use before 2014, do youplan to demonstrate MU by 10/1/14?Do you qualify for a hardshipexemption for the 2015 paymentadjustment for MU? (see slide20)?You will avoid the2015 Medicare MUpaymentadjustment if youapply for anexemption by6/30/14Do you expect tobe subject to 2014eRx paymentadjustment?You will be subjectto a Medicare MUpaymentadjustment of1.0% in 2015You will be subjectto a Medicare MUpaymentadjustment of 2.0%in 2015You may earn a MU incentive* in2014 and avoid the 2015 & 2016Medicare MU payment adjustmentif you start by 7/1/14*Earn $21,250 if no prior year ofA/I/U and 2014 is first year of MU;earn $8,500 if there was a prioryear of A/I/U and 2014 is first yearof MUNoYesNoNoYesYes2013 Medicaid HITECH Meaningful Use Decision Tree23
  • 24. 2013 PQRS Decision Tree:Individuals and Groups <100Do you plan to participate in PQRS in 2013?Yes No24
  • 25. You will earn a 0.5%PQRS incentive (paidin 2014) and avoid the2015 PQRS paymentadjustmentYou will be subject to a PQRS payment adjustmentof 1.5% in 2015 (no Value Based Modifieradjustment)*You can avoid the 2015 payment adjustment byapplying for the Administrative Claims option ORby submitting one valid measure or measuresgroupQ: Do you plan to participate in PQRS in 2013?Will you participate in aqualified Maintenance ofCertification program in2013?You will earn a 1.0%PQRS incentive (paidin 2014) and avoid the2015 PQRS paymentadjustmentNoYesYes No2013 PQRS Decision Tree:Individuals and Groups <100, cont.25
  • 26. 2013 PQRS Decision Tree:Groups ≥ 100Do you plan to participate in PQRS in2013?Yes No26
  • 27. You will be subject to a PQRSpayment adjustment of 1.5%in 2015 AND a Value BasedModifier downwardadjustment of 1.0% in 2015*You can avoid the 2015 PQRSpayment adjustment byapplying for theAdministrative Claims optionOR by submitting one validmeasure or measures group*Individual EPs in groups ≥100 can avoid VBMadjustment by applying for theAdministrative Claims optionOR by submitting one validmeasure or measures groupper NPIWill you elect the quality-tiering calculation methodfor application of Value Based Modifier?How do you expectCMS to rate yourQUALITY of care?You may earn a 0.5% PQRSincentive (paid in 2014 basedon 2013 Medicare payments;1.0% if MOC); avoid 2015PQRS payment adjustment;no VBM adjustmentCOSTRatingVBM Adj.Low +2.0xMed +1.0xHigh noneCOSTRatingVBM Adj.Low +1.0xMed NoneHigh -0.5%COSTRatingVBM Adj.Low NoneMed -0.5%High -1.0%Do you plan to participate in PQRS in 2013?You may earn a 0.5% PQRSincentive (paid in 2014based on 2013 Medicarepayments; 1.0% if MOC);avoid 2015 PQRS paymentadjustmentNo YesNoYesLowHigh Medium2013 PQRS Decision Tree:Groups ≥ 100, cont.27
  • 28. ResourcesNEW!!! CMS eHealth Webpagehttp://www.cms.gov/ehealth/• PQRS Website– http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/• eRx Incentive Program Website– http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/• Medicare and Medicaid EHR Incentive Programs– http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/• Value Based Modifier (VBM)– http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/ValueBasedPaymentModifier.html• Frequently Asked Questions (FAQs)– https://questions.cms.gov/28
  • 29. Where to Call for Assistance• QualityNet Help Desk:– Portal password issues– PQRS/eRx feedback report availability and access– IACS registration questions– IACS login issues– Program and measure-specific questions• 866-288-8912 (TTY 877-715-6222)• 7:00 a.m.–7:00 p.m. CST M-F or qnetsupport@sdps.org• You will be asked to provide basic information such as name, practice, address, phone,and e-mail• Provider Contact Center:– Questions on status of 2012 PQRS/eRx Incentive Program incentive payment (duringdistribution timeframe)– See Contact Center Directory at:– http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/provider-compliance-interactive-map/index.html• EHR Incentive Program Information Center:– 888-734-6433 (TTY 888-734-6563)29
  • 30. Contact InfoPatrick HamiltonHealth Insurance SpecialistCenters for Medicare & MedicaidServicesPhiladelphia Regional OfficePhone: (215) 861-4097E-mail: patrick.hamilton@cms.hhs.govBarbara Connors, D.O., M.P.H.Chief Medical Officer, Region IIICenters for Medicare & MedicaidServicesPhiladelphia Regional OfficePhone: (215) 861-4218E-mail: barbara.connors@cms.hhs.govCMS is now on Twitter!!Follow us at @CMSGOV30