How to earn incentives and avoid penalties in 2014

Medicare's three key incentive programs—the Medicare Electronic Health Records (EHR) Incentive Program, Medicare Physician Quality Reporting System (PQRS), and Medicare e-Prescribing (e-Rx) Incentive Program—are changing.

Maximum bonuses for successful participation are rapidly reducing.

Maximum bonuses for successful participation are rapidly reducing, while penalties for those who do not participate are increasing.

These programs could still offer optometrists incentives up to $12,000 plus 1 percent of total allowed charges during 2014, depending on when they began participating. If they do not participate this year, they could see Medicare reimbursements reduced up to 4 percent in 2016.

EHR incentive program

During 2014, the Medicare EHR Incentive Program offers the following incentives:

  • Up to $12,000 for those in the first or second year of participation
  • Up to $8,000 for those in the third year
  • Up to $4,000 for those in the fourth year.

As in the past, practitioners in the first or second year of participation will have to meet the program's Stage 1 EHR utilization criteria to earn bonuses. All others now will have to meet the program's new Stage 2 meaningful use standards. 2014 will be the last year practitioners will be able to enter the EHR incentive program.

Practitioners who did not meet EHR requirements during 2013 will see their Medicare reimbursements docked 1 percent during 2015. Those who fail to meaningfully use EHRs in 2014 will see payments reduced 2 percent in 2016.

However, those participating for the first time this year can avoid the 2015 and 2016 penalty by demonstrating meaningful use for 90 days—and then attest to meeting the program requirements prior to October 1.

PQRS/MOC program

The Medicare PQRS and its Maintenance of Certification (MOC) program will each offer bonuses equaling 0.5 percent of a practitioner's total approved Medicare reimbursements for the year.

The Medicare PQRS will offer incentive payments for the final time in 2014, again offering a 0.5 percent payment bonus for those who report designated care quality improvement measures.

Those who do not report PQRS quality measures will have their Medicare payment reduced by 2 percent during 2016. This penalty for nonparticipation in the PQRS program will remain in effect through at least 2019.

Only the Medicare PQRS Maintenance of Certification (MOC) Program will not reduce its bonus in 2014.

Need additional information? The AOA's Third Party Center on Jan. 21 held an Ask the Coding Experts webinar on PQRS updates for 2014 (member log-in required).

e-Rx program

No incentives will be available under the Medicare e-Rx Incentive Program. However, optometrists will not be subject to payment penalties if they do not e-prescribe.

After offering payment bonuses for the past three years to practitioners who e-prescribe, the e-Rx program in 2014 will become the first in Medicare to rely solely on disincentives to influence practitioner behavior.

Most practitioners who do not e-prescribe will see their Medicare reimbursements docked at least 2 percent—but optometrists are specifically exempted. However, optometrists will be subject to other Medicare payment penalties.

January 16, 2014

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