To avoid future penalties, act now

To avoid future penalties, act now

Taken together, solo optometrists who do not participate in PQRS or the EHR incentive program in 2015 could face a 7 percent payment reduction on Medicare covered services billed in 2017.

Doctors who do not satisfactorily report data on quality measures and do not participate in the Electronic Health Record (EHR) Incentive Programs this year will see payment reductions two years from now.

To avoid the 2017 payment reductions, doctors must satisfactorily meet performance and participation expectations in each of these programs: the Physician Quality Reporting System (PQRS), EHR Meaningful Use Program and the Value-based Modifier (VBM) program.

Outlined below are the basic steps that need to be taken to participate in these programs to avoid penalties in 2017.

PQRS payment penalties
A negative payment reduction of 2 percent will be applied in 2017 for covered services billed by Medicare physicians who do not satisfactorily participate in PQRS in 2015.

To avoid these penalties, doctors must:

AOA has developed extensive resources to assist optometrists in PQRS participation, and members can access these resources, including webinars, publications and other resources, by clicking here.

Medicare EHR Incentive Program payment reductions
A negative payment reduction of 3 percent will be assessed in 2017 for all Medicare physicians who are not meaningful users of an EHR in 2015. This reduction will be applied to covered professional services provided by the doctor during 2017.

To avoid these penalties, doctors must:

Optometrists who did not successfully participate in the incentive program in 2014 will see a 2 percent payment reduction beginning on Jan. 1, 2016. However, there are hardship exemptions available for doctors who meet certain requirements. These doctors can avoid the 2016 payment reduction by applying for a 2016 hardship exception by 11:59 p.m. ET, July 1, 2015.  For more information on the specific hardship exemptions available and the necessary paperwork that must be submitted, click here.

VBM payment adjustments
The basis of the VBM is participation in PQRS. Optometrists with nine or fewer doctors in their practice can avoid any penalties under the VBM simply by participating in PQRS. Those optometrists who do not participate in PQRS will receive the 2 percent PQRS payment reduction and an additional 2 or 4 percent VBM payment reduction based on practice size.

To avoid these penalties, doctors must:

  • Participate in PQRS.

  • Access your Quality Resource and Use Report (QRUR).

  • Know how your practice might be evaluated.

AOA has developed a VBM resource page where doctors can find more information about how VBM will impact reimbursement in 2017 and into the future. 

Taken together, solo optometrists who do not participate in PQRS or the EHR incentive program in 2015 could face a 7 percent payment reduction for Medicare services billed in 2017.

For questions or additional information, contact Kara Webb, AOA associate director for coding and regulatory policy, at kcwebb@aoa.org.

June 9, 2015

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