Posted on Thu, May 16, 2013 @ 11:23 AM
Guidance for Eligible Professionals: How to Participate in Both the Medicare EHR Incentive Program and PQRS in 2013 and Beyond
Providers who treat Medicare patients and bill for Part B services on the Medicare Physician Fee Schedule (PFS) may be eligible for two incentive programs at CMS: the Medicare EHR Incentive Program and the Physician Quality Reporting System (PQRS) program. CMS encourages you to read more to learn about the opportunity to participate in both.
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Posted on Tue, May 07, 2013 @ 09:19 AM
More than 250,000 physicians and other medical professionals eligible for the federally funded electronic health record incentive payment programs have received payments, according to the latest government data.
In its monthly update about the programs (PDF), the CMS reports that through March, a total of 255,772 so-called “eligible professionals,” or EPs, have been paid—160,890, or 63% of them so far, through the federally administered Medicare EHR incentive payment program, 83,765, or 33%, through state-run Medicaid programs; and 11,117, or 4%, through the federal Medicare Advantage program.
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Posted on Tue, Apr 30, 2013 @ 10:46 AM
The increased use of electronic health record systems helped reduce costs in Canada's health care system by about 1.3 billion Canadian dollars -- or about $1.27 billion -- over six years, according to a new study by PricewaterhouseCoopers, EHR Intelligence reports (Bresnick, EHR Intelligence, 4/22).
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Posted on Fri, Apr 26, 2013 @ 10:19 AM
The NFL draft is getting underway, and the league has made a draft choice of its own: It has called on eClinicalWorks to create a mobile electronic health record that will be used by team caregivers to provide real-time access to player videos and information on how to diagnose and treat sports injuries.
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Posted on Fri, Apr 12, 2013 @ 09:17 AM
It’s not just about demonstrating Meaningful Use in 2013. CMS will now be performing pre-payment audits in addition to the post-payment Meaningful Use audits. Before mailing out some bonus checks, CMS says the audits (which will affect 5-10% of incentive applications) will be random and start with attestations submitted during and after January 2013.
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Posted on Sat, Apr 06, 2013 @ 02:10 PM
Medicare PECOS Edits Begin May 1, 2013 - Claim Denials Possible
Effective May 1, 2013, the Centers for Medicare & Medicaid Services (CMS) will turn on the Phase 2 denial edits. This means that Medicare will deny claims for services or supplies that require an ordering/referring provider to be identified and that provider is not identified, is not in Medicare's enrollment records, or is not of a specialty type that may order/refer the service/item being billed.
The Affordable Care Act, Section 6405, “Physicians Who Order Items or Services are Required to be Medicare Enrolled Physicians or Eligible Professionals,” requires physicians or other eligible professionals to be enrolled in the Medicare Program to order or refer items or services for Medicare beneficiaries. Some physicians or other eligible professionals do not and will not send claims to a Medicare contractor for the services they furnish and therefore may not be enrolled in the Medicare program. Also, effective January 1, 1992, a physician or supplier that bills Medicare for a service or item must show the name and unique identifier of the attending physician on the claim if that service or item was the result of an order or referral. Effective May 23, 2008, the unique identifier was determined to be the National Provider Identifier (NPI). The Centers for Medicare & Medicaid Services (CMS) has implemented edits on ordering and referring providers when they are required to be identified in Part B, DME, and Part A HHA claims from Medicare providers or suppliers who furnished items or services as a result of orders or referrals.
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Posted on Thu, Apr 04, 2013 @ 10:12 AM
Medicare Advantage Payments to be Increased Instead of Cut
Medicare Advantage customers need not fear the painful benefit cuts in 2014 as anticipated by Health Insurers. CMS backtracked on plans to cut Medicare Advantage payments to insurers by 2.2% in 2014 and instead decided on a 3.3% increase.
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Posted on Fri, Mar 29, 2013 @ 07:40 PM
As the deadline for implementation in the U.S. draws near, talk of electronic medical records (EMR) and electronic health records (EHR) software is a hot topic at the doctor’s office lately. These systems assist medical practitioners in the creation, storage, and organization of electronic medical records, including patient charts, electronic prescriptions, lab orders, and evaluations (just to name a few common features). While the terms “EMR” and “EHR" are often used interchangeably, EMR solutions allow for patient information to be shared within one health care organization, whereas EHR solutions allow for health-related records to be shared across multiple organizations. Below is a look at some of the most popular options in both categories.
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Posted on Fri, Mar 29, 2013 @ 10:37 AM
Purpose
This article provides information on the 2015 PQRS payment adjustment and guidance on how individual eligible professionals and group practices can avoid the 2015 PQRS payment adjustment. Information provided in this article is based on the 2013 Medicare PFS Final Rule.
This article focuses on the PQRS payment adjustment and does not provide guidance for Value-Based Payment Modifier upward adjustment or payment adjustments from other Medicare sponsored programs. See the Additional Information section below for links to the CMS Value-Based Payment Modifier website, and the Medicare and Medicaid EHR Incentive Program website.
Background
Section 1848(a)(8) of the Social Security Act, requires the Centers for Medicare & Medicaid Services (CMS) to subject eligible professionals and group practices who do not report data on Physician Quality Reporting System (PQRS) quality measures for covered professional services during the 2013 program year for a payment adjustment beginning in 2015. Eligible professionals and group practices receiving a PQRS payment adjustment in 2015 will be paid 1.5% less than the PFS amount for services rendered January 1-December 31, 2015.
The applicable percent for payment adjustments under PQRS are as follows:
- 1.5% adjustment in 2015 (eligible professional will receive 98.5% of his/her allowed Medicare Part B PFS amount for covered professional services that would otherwise apply to such services)
- 2.0% adjustment in 2016 and subsequent years (eligible professional will receive 98% of his/her allowed Medicare Part B PFS amount for covered professional services that would otherwise apply to such services)
2015 PQRS Payment Adjustment Eligibility
Those providers considered eligible and able to participate in PQRS as outlined on the CMS PQRS website could be subject to the 2015 PQRS payment adjustment. Eligible professionals working for more than one organization need to meet the reporting criteria for each tax identification number (TIN) under which (s)he works during the 2013 PQRS program year to avoid the 2015 PQRS payment adjustment for each TIN. Those groups who self-nominate or register to participate in PQRS as a group through the group practice reporting option (GPRO) or participate as an ACO GPRO will be analyzed at the TIN level; therefore, all providers under that TIN who bill Medicare Part B PFS will be included in analysis for purposes of the 2015 PQRS payment adjustment.
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Posted on Tue, Mar 05, 2013 @ 02:25 PM
Medical Office Managers - Do you have a Self-Pay Strategy?
With the growing costs of healthcare, patients are required to pay more out of their pockets than ever before! Medical insurance deductibles and co-payments are on the rise while fewer necessary procedures are covered in-full by many insurance companies. According to ACA International, 29 percent of adults reported medical debt or trouble paying medical bills, and 16 percent had been contacted by a collection agency for unpaid medical bills.
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