CMS Incentives and Penalties
 

CMS Incentives and Penalties

on

  • 1,569 views

Health care providers today face an overwhelming number of change initiatives that aim to move the provider community in a given direction by leveraging incentives and penalties. Learn about all of ...

Health care providers today face an overwhelming number of change initiatives that aim to move the provider community in a given direction by leveraging incentives and penalties. Learn about all of the incentives and penalties CMS is leveraging to drive health care reform.

Statistics

Views

Total Views
1,569
Views on SlideShare
1,152
Embed Views
417

Actions

Likes
0
Downloads
10
Comments
0

2 Embeds 417

http://info.successehs.com 416
http://www.linkedin.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

CMS Incentives and Penalties CMS Incentives and Penalties Presentation Transcript

  • CMS Incentives & Penalties:An Overview of the Carrots & Sticks of Health Reform
  • Health care providers today face anoverwhelming number of changeinitiatives that aim to move the providercommunity in a given direction byleveraging incentives and penalties—otherwise known as "carrots and sticks."
  • Many of the CMS program penalties arecumulative, meaning providers who failto meet the requirements for PQRSreporting, e-Prescribing, Meaningful Useand other programs will be subject to allamassed payment adjustments.
  • CMS Incentives & Penalties Program 2012 2013 2014 2015 2016 2017Medicare e- CarrotsPrescribing 1.0% 0.5%Incentive Program* Sticks -1.0% -1.5% -2.0%Medicaid EHR CarrotsIncentive Program Year 1: $21,250 Year 1: $21,250 Year 1: $21,250 Year 1: $21,250 Year 1: $21,250 Year 1: $21,250 Years 2-6: Years 2-6: Years 2-6: Years 2-6: Years 2-6: Years 2-6: $8,500 $8,500 $8,500 $8,500 $8,500 $8,500Medicare EHR CarrotsIncentive Program Up to $18,000 Up to $15,000 Up to $12,000 Up to $8,000 Up to $4,000 Sticks -1.0% -2.0% -3.0%ICD-10 Changeover Carrots Sticks None None No $ No $ No $ No $CMS Physician Carrots SticksQuality Reporting 0.5% 0.5% 0.5% -1.5% -2.0% -2.0%SystemCMS Value-Based Carrots Carrots/SticksModifiers None None None +/- TBD +/- TBD +/- TBD
  • Medicare e-Prescribing Incentive Program Program 2012 2013 2014 2015 2016 2017Medicare Carrotse-Prescribing 1.0% 0.5%Incentive Program* Sticks - -1.5% -2.0% 1.0%
  • Medicare e-PrescribingIncentive ProgramIncentives: • Reporting period: Jan. 1 - Dec. 31, 2012 (no sign-up required) • Three ways to report: claims, registry or EHR Direct • Claims-based Reporting: HCPCS Code G8553 on 25 unique visits
  • Medicare e-PrescribingIncentive ProgramPenalties: • Reporting Period: Jan. 1 – June 30, 2012 • Claims-based Reporting: Must report HCPCS code G8553 on 10 unique visits by 7.27.2012 to avoid the penalty
  • Medicare EHR Incentive Program Program 2012 2013 2014 2015 2016 2017Medicare EHR CarrotsIncentive Program Up to Up to Up to Up to Up to $18,000 $15,000 $12,000 $8,000 $4,000 Sticks -1.0% -2.0% -3.0% ** Meaningful Use incentives will vary based upon the EP’s year initiated and allowable charges.
  • Medicare EHRIncentive Program • Eligible Provider Types - MD, DO, DDS, DMD, DPM, OD, DC • Must have PECOS Number with CMS • Must register with CMS at cms.gov/EHRIncentivePrograms/
  • Medicare EHRIncentive Program• Year 1: 15 Core + 5 Menu Objectives/Measures for continuous 90 days• Year 2 and Beyond: Full Year of Meaningful Use
  • Medicaid EHR Incentive Program Program 2012 2013 2014 2015 2016 2017Medicaid CarrotsEHR Year 1: Year 1: Year 1: Year 1: Year 1: Year 1:Incentive $21,250 $21,250 $21,250 $21,250 $21,250 $21,250Program Years 2- Years 2- Years 2- Years 2- Years 2- Years 2- 6: 6: 6: 6: 6: 6: $8,500 $8,500 $8,500 $8,500 $8,500 $8,500
  • Medicaid EHR IncentiveProgram• Year 1: Adopt, Implement or Upgrade Certified EHR• Year 2: Demonstrate Meaningful Use for 90 continuous days• Years 3 through 6: Demonstrate Meaningful Use for full year
  • The ICD-10 Changeover Program 2012 2013 2014 2015 2016 2017ICD-10 Carrots SticksChangeover None None No $ No $ No $ No $
  • The ICD-10 Changeover• Effective Date: Oct. 1, 2013; NPRM pending for delay to Oct. 1, 2014• Transition requires maintenance of both ICD-9 and ICD-10: o DOS < Oct. 1, 2014 → ICD-9 o DOS = Oct. 1, 2014 or > → ICD-10
  • The ICD-10 Changeover• CMS and other payers cannot process ICD-10 claims before Oct.1, 2014• Applies to all payers and providers• Does not affect CPT coding
  • CMS Physician Quality Reporting System Program 2012 2013 2014 2015 2016 2017CMS Physician Carrots SticksQuality Reporting 0.5% 0.5% 0.5% -1.5% -2.0% -2.0%System
  • CMS Physician QualityReporting System$1,000• Penalties begin in 2015, but are based on participation in 2013• Three ways to report: claims, registry or EHR Direct• Eligible Professionals include those who provide services paid based on the Medicare PFS
  • CMS Value-Based ModifierPayment Program Program 2012 2013 2014 2015 2016 2017CMS Value- Carrots Carrots/SticksBased None None None +/- TBD +/- TBD +/- TBDModifiers
  • CMS Value-Based ModifierPayment Program• VBM will compensate physicians differentially based upon a composition of quality and costs.• Physician performance will be measured by clinical data reported through PQRS between 2015 and 2017
  • CMS Value-Based ModifierPayment Program• The VBM applied will be -1 percent in CY2015 for groups of more than 25 physicians that do not participate in PQRS in CY2013, which is the performance period for the initial VBM.
  • Want more details oneach program?• e-Prescribing Incentive Program• EHR Incentive Programs• Physician Quality Reporting System• ICD-10• CMS Value-Based Payment Modifier
  • Learn more!Our website hosts a wealth of freeresources, including white papers, casestudies, industry blog, newslettercovering current events in health care,tips and tricks for your practice, andother informative articles. www.successehs.com