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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 gi...
Many of the CMS program penalties arecumulative, meaning providers who failto meet the requirements for PQRSreporting, e-P...
CMS Incentives & Penalties     Program             2012               2013             2014               2015            ...
Medicare e-Prescribing  Incentive Program      Program          2012             2013      2014 2015 2016 2017Medicare    ...
Medicare e-PrescribingIncentive ProgramIncentives: • Reporting period: Jan. 1 - Dec. 31,   2012 (no sign-up required) • Th...
Medicare e-PrescribingIncentive ProgramPenalties: • Reporting Period: Jan. 1 – June 30,   2012 • Claims-based Reporting: M...
Medicare EHR Incentive Program     Program             2012        2013        2014       2015        2016        2017Medi...
Medicare EHRIncentive Program • Eligible Provider Types - MD, DO,   DDS, DMD, DPM, OD, DC • Must have PECOS Number with   ...
Medicare EHRIncentive Program• Year 1: 15 Core + 5 Menu  Objectives/Measures for continuous  90 days• Year 2 and Beyond: F...
Medicaid EHR Incentive Program  Program    2012       2013       2014       2015       2016       2017Medicaid            ...
Medicaid EHR IncentiveProgram• Year 1: Adopt, Implement or  Upgrade Certified EHR• Year 2: Demonstrate Meaningful  Use for...
The ICD-10 Changeover  Program    2012     2013   2014   2015            2016   2017ICD-10          Carrots               ...
The ICD-10 Changeover•   Effective Date: Oct. 1, 2013; NPRM    pending for delay to Oct. 1, 2014•   Transition requires ma...
The ICD-10 Changeover•   CMS and other payers cannot process    ICD-10 claims before Oct.1, 2014•   Applies to all payers ...
CMS Physician Quality Reporting System      Program       2012    2013     2014   2015    2016     2017CMS Physician      ...
CMS Physician QualityReporting System$1,000•   Penalties begin in 2015, but are    based on participation in 2013•   Three...
CMS Value-Based ModifierPayment Program  Program    2012    2013     2014    2015         2016          2017CMS Value-    ...
CMS Value-Based ModifierPayment Program•   VBM will compensate physicians    differentially based upon a    composition of...
CMS Value-Based ModifierPayment Program•   The VBM applied will be -1 percent in    CY2015 for groups of more than 25    p...
Want more details oneach program?•   e-Prescribing Incentive Program•   EHR Incentive Programs•   Physician Quality Report...
Learn more!Our website hosts a wealth of freeresources, including white papers, casestudies, industry blog, newslettercove...
CMS Incentives and Penalties
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CMS Incentives and Penalties

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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.

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Transcript of "CMS Incentives and Penalties"

  1. 1. CMS Incentives & Penalties:An Overview of the Carrots & Sticks of Health Reform
  2. 2. 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."
  3. 3. 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.
  4. 4. 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
  5. 5. 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%
  6. 6. 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
  7. 7. 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
  8. 8. 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.
  9. 9. 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/
  10. 10. Medicare EHRIncentive Program• Year 1: 15 Core + 5 Menu Objectives/Measures for continuous 90 days• Year 2 and Beyond: Full Year of Meaningful Use
  11. 11. 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
  12. 12. 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
  13. 13. The ICD-10 Changeover Program 2012 2013 2014 2015 2016 2017ICD-10 Carrots SticksChangeover None None No $ No $ No $ No $
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. CMS Value-Based ModifierPayment Program Program 2012 2013 2014 2015 2016 2017CMS Value- Carrots Carrots/SticksBased None None None +/- TBD +/- TBD +/- TBDModifiers
  19. 19. 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
  20. 20. 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.
  21. 21. Want more details oneach program?• e-Prescribing Incentive Program• EHR Incentive Programs• Physician Quality Reporting System• ICD-10• CMS Value-Based Payment Modifier
  22. 22. 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
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