Medicare Bonus & Penalty Information
New Medicare initiatives present a unique opportunity for
you to demonstrate the quality of the care you provide and to increase your net
revenue, offering bonus payments that reward value in primary care rather than
volume.
If you have not already done so, implementing the Medicare initiatives in 2013
(instead of waiting until 2014) could potentially save you more than $19,000
per physician in your practice.*
The more you do now, the better off you'll be. Early implementation of
Meaningful Use of EHR (MU), e-prescribing (eRX), and the Physician Quality
Reporting System (PQRS) enables you to capture bonus payments and avoid
penalties.
Consider the potential financial impact of different implementation dates for a
small private practice of three physicians with $1.425 million total annual
revenue and a 20% Medicare payer mix. The following table outlines the
cumulative potential bonuses and potential penalties associated with this
practice implementing the new Medicare initiatives of Meaningful Use of EHR, e-prescribing,
and PQRS in 2013, 2014, or 2015.
Year Practice
Begins Meaningful Use of EHR, eRX, & PQRS: 2013†
|
|
Total
|
MU
|
eRX
|
PQRS
|
|
2013
|
Total: $43,575
|
MU: $45,000
|
eRX: -$2,850
|
PQRS: $1,425
|
|
2014
|
Total: $37,425
|
MU: $36,000
|
eRX: $0
|
PQRS: $1,425
|
|
2015
|
Total: $24,000
|
MU: $24,000
|
eRX: $0
|
PQRS:
|
|
3-year
Total
|
Total: $105,000
|
MU: $105,000
|
eRX: -$2,850
|
PQRS: $2,850
|
Year Practice
Begins Meaningful Use of EHR, eRX, & PQRS: 2014†
|
|
Total
|
MU
|
ERX
|
PQRS
|
|
2013
|
Total: -$4,275
|
MU: $0
|
ERX: -$4,275
|
PQRS: $0
|
|
2014
|
Total: $31,725
|
MU: $36,000
|
ERX: $5,700
|
PQRS: $1,425
|
|
2015
|
Total: $19,725
|
MU: $24,000
|
ERX: $0
|
PQRS: -$4,275
|
|
3-year
Total
|
Total: $47,175
|
MU: $60,000
|
ERX: -$9,975
|
PQRS: -$2,850
|
† Calculations based on implementation before the end of
the calendar year.
This information is designed to provide generalized
financial impact information for a typical family physician practicing
primarily in a private practice setting. It provides a summary of the main
aspects of several government programs and financial information that will
allow eligible small- and medium-size practices to make informed decisions
regarding their implementation of these programs.
The Medicare Electronic Health Record (EHR) Incentive
Program provides bonus payments to eligible professionals who demonstrate
meaningful use (MU) of certified EHR technology.
The cumulative payment amount depends on the year in which a professional
begins participating in the program. Physicians whose participation starts in
2013 may receive up to $39,000 in cumulative payments; physicians who start in
2014 may receive up to $24,000.
Penalties for those who do not demonstrate MU of EHR are set to begin in 2015.
Electronic Prescribing
The Electronic Prescribing (eRx) Incentive Program offers
a bonus of 0.5% for eligible professionals who successfully use electronic
prescriptions for their Medicare Part B services by the end of 2013. Eligible
professionals who have not successfully used electronic prescriptions for their
Medicare Part B services will be penalized in 2013 and 2014.
To avoid this penalty, you must have met the program's requirements by June 30
of the prior year (e.g., to avoid a penalty in 2014, requirements must be met
by June 30, 2013).
The Physician Quality Reporting System (PQRS) includes a
bonus payment for eligible professionals who report data on quality measures
for covered services provided to Medicare Part B Fee-for-Service beneficiaries.
Individual eligible professionals may choose from multiple reporting options
for either individual or group measures. Group practice reporting options are
also available.
PQRS reporting deadlines are based on the method of reporting. If you qualify
for PQRS bonuses in 2013 and 2014, you will avoid penalties in 2015 and 2016,
respectively.
An additional bonus of 0.5% is available for eligible professionals who work
with a qualified Maintenance of Certification (MOC) entity and complete certain
other requirements from 2012 through 2014.
You should also
consider:
Beginning in 2015, payment rates under the Medicare
Physician Fee Schedule for groups of 100 or more eligible professionals will be
subject to a value-based payment modifier (VBPM). By 2017, this modifier will
be implemented for all physicians.
Physicians who do not demonstrate higher quality and lower costs will receive
lower payments. The VBPM is based on performance two years prior (e.g.,
application of the VBPM in 2015 will be based on physician performance in
2013). Eligible professionals may avoid penalties by successfully participating
in the PQRS
For more details contact:
HPP-Accuchecker 305-227-2383
Source:
CMS.gov
American Academy of Family Physicians
