CMS Presentation on Avoiding EPrescribing and PQRS Penalties
The presentation for the Center for Medicare & Medicaid Services (CMS) Feb 19, 2013 call on How to Avoid a 2014 eRx and 2015 PQRS Payment Adjustment National Provider Call is currently available for download from the CMS website.
This is important information regarding the:
Payment Adjustment Update
PQRS Payment Adjustment/Value Modifier
Beginning in 2015, eligible professionals that do not participate in PQRS or elect Administrative Claims during the 2013 program year will be subject to a payment adjustment of -1.0 percent. In addition, new federal regulations require that medical practice groups comprised of 100 or more eligible professionals (as of October 15, 2013) will be subject to the value-based payment modifier- based on performance in 2013. Groups of this size that fail to self-nominate/register for PQRS – as a group – will see a 1 percent negative impact on all physician payment under the Medicare PFS in calendar year 2015. Groups meeting the size threshold must sign-up as a group during one of two sign-up periods to participate in the 2013 PQRS. The first opportunity for group practices to sign-up ended on January 31, 2013. There will be a second opportunity to sign up July 15, 2013 through October 15, 2013.
For more information about avoiding the payment adjustment, please view the following resources:
eRx Payment Adjustment
Please note, while these slides are a broad summary of the eRx Program, many anesthesiologists will continue to be automatically excluded from the incentives and penalties associated with the e-prescribing program. On Slide 8, CMS stated that eligible professionals are automatically exempt from the 2014 eRx payment adjustment if they do not “have more than 10 percent of an individual eligible professional’s allowed charges for the 2013 eRx 6-month reporting period (1/1/13–6/30/13) comprised of codes in the denominator of the 2012 eRx measure” or do not “have more than 100 cases containing an encounter code in the measure’s denominator during the 2013 eRx 6-month reporting period.” These encounters are predominantly evaluation and management services and can be found in the 2012 measure specification. In those cases a physician does not need to file for a hardship exemption for 2014.
The eRx program and hardship exemptions are particularly applicable to our ASA members who issue prescriptions to patients, such as pain physicians. On slide 15, CMS restates the hardship exemption categories, these include:
- Unable to electronically prescribe due to local, state, or federal law, or regulation (In some cases, electronic prescriptions for controlled substances may be subject to such laws or regulations).
- Has or will prescribe fewer than 100 prescriptions during the 6-month reporting period.
- Practices in a rural area without sufficient high-speed Internet access .
- Practices in an area without sufficient available pharmacies for electronic prescribing.
- Does not have prescribing privileges during the 6-month reporting period.
- Eligible professionals or group practices who achieve Meaningful Use during certain eRx payment adjustment reporting period. Determined by CMS through review of the EHR Incentive Program
- Attestation and Registration system and will be automatically processed by CMS.
- Eligible professionals or group practices who demonstrate intent to participate in the EHR Incentive Program and adoption of Certified EHR Technology. Determined by CMS through review of the EHR Incentive Program Attestation and Registration system and will be automatically processed by CMS.
On Slide 16, CMS states that hardship exemptions for 2014 must be submitted on or before June 30, 2013.
February 28 is the Last Day for Eligible Professionals (EPs) to Submit Medicare Part B Claims for CY2012
February 28, 2013 is the deadline for EPs to submit any pending Medicare Part B claims from calendar year (CY) 2012, as CMS allows 60 days after December 31, 2012, for all pending claims to be processed. This means that EPs have 60 days in 2013 to submit claims for allowed charges incurred in 2012.