I wanted to share a little of the research I've done on Medicare "incentives." You may have seen my other posts on "New Medicare Annual Wellness Visit" Here is some of what I learned this year and sent out to my FP friends on my e-mail and in our little community (and to docs on our community hospital's medical staff)...
MEDICARE EHR INITIATIVE
PRIMARY CARE INCENTIVE PROGRAM
MEDICARE E-PRESCRIBING INITIATIVE
The Medicare EHR Incentive Program
http://www.cms.gov/EHRIncentivePrograms/rolled out phase one this week with open registration beginning January 3rd
Registration is at
http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.aspIn order to register you need you NPPES ID and password
(call 1-800-465-3203 to get it if you don't know it - you needed it to get an NPI number)
In the wisdom of the government, although you can register now, you must still go back in April and attest to meaningful use of your qualifying EHR. But, at least you can get started on that road to $44,000 over five years.
The Medicare EHR Incentive Program will provide incentive payments to eligible professionals that demonstrate meaningful use of certified EHR technology.
To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012.
Important! For 2015 and later, Medicare eligible professionals,
eligible hospitals, and CAHs that do not successfully demonstrate meaningful use will have a payment adjustment in their Medicare reimbursement.
Primary Care Incentive
The Affordable Care Act (specifically, Section 5501(a)) provides for an incentive payment for primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care practitioner. The Primary Care Incentive Program (PCIP) payment will be paid on a quarterly basis in an amount equal to 10 percent of the payment amount for services under Part B.
To qualify: a physician (or non-physician practitioner) must be
enrolled in medicare, self designate as primary care (general internal medicine, family practice, pediatrics, and geriatrics) AND in the 2 years prior to the bonus payment, over 60 percent of allowed charges from medicare must come from E&M codes in the following ranges:
99201?99215 (office visits), 99304?99340 (nursing home/rest
home/assisted living), 99341?99350 (home visits).
Actually, the formula is based on Physician Fee Schedule - so clinical lab charges and medications / biologics won't count against you. Also the formula does not count against you E&M charges from hospital visits or inpatient/obs visits. So if you still see / saw folks in the hospital or ED setting - it wouldn't count against you. (thank you American College of Physicians for those lobbying efforts -Not the AMA-)
If you want the headache and care to see the "simple" formula: click on the following link
http://www.acponline.org/running_practice/practice_management/payment_coding/bonus3.gifIN SUMMARY:
10 percent bonus for E&M codes paid quarterly to qualifying docs (and mid-levels). No need to enroll for this bonus - it is automatic. Bonus period is defined as 2011-2015
A list of all NPI numbers for eligible practitioners was to be sent from CMS to Trailblazer (our fiscal intermediary) and put on their website prior to Jan 01, 2011. As of now, I cannot find it on their website: PCIP Eligibility File
Medicare E-prescribing initiative
If you are not e-prescribing and submitting your G code to medicare (G8553, if you don't know it already) by June, you will be penalized in 2012.
If use of the following codes comprise 10% or more of your allowable charges from medicare than this applies to you:
90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, (Psychiatrists)
92002, 92004, 92012, 92014, (Ophthalmologists)
96150, 96151, 96152, (Health and Behavior Assessments)
99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215,(office E&M)
99304, 99305, 99306, 99307, 99308, 99309, 99310, (Nursing Facility codes)
99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, (Rest Homes)
99341, 99342, 99343, 99345, 99347, 99348, 99349, 99350, (Home Visits)
G0101, (Medicare Pap)
G0108, G0109 (Diabetes Self-Management Training)
Specifically, you must submit 10 (yes only ten) G codes showing you are using e-prescribing on medicare patients for each practitioner in your group by June 2011. Failure to do so - hits you with a 1% penalty on ALL 2012 payments. 99% of medicare allowable from medicare on all part B Physician Fee Schedule services. Not cool.
Section 132 of the Medicare Improvements for Patients and Providers
Act of 2008 (MIPPA) authorizes CMS to apply this payment
adjustment whether or not the EP is planning to participate in the Electronic Prescribing (eRx) Incentive Program.
Uh, oh. So if you take money from medicare you need to e-prescribe. And document your e-prescribing with the use of the G code at least 10 times before June. TELL YOUR FRIENDS!
There are three exceptions, AND you must use G codes to document you have an exception.
G8642 ? you practice in a rural area without sufficient high-speed Internet access and request a hardship exemption from the application of the payment adjustment. (no clue how many times you must submit this code)
G8643 ? you practice in an area without sufficient available
pharmacies for electronic prescribing and request a hardship exemption from the application of the payment adjustment. (no clue how many times you must submit this code)
Additionally, there is to be a ?G? code that can be used to indicate you do not have prescribing privileges. Reporting this ?G? code will prevent you from being subjected to a payment adjustment in 2012. - I doubt this code applies to any of us.
But, I cannot find the listing of this G code anywhere.
GOOD LUCK!
