CMS incentive programs: Key dates and deadlines for ODs

July 9, 2013

Microsoft Word - 6 - CMS Incentive Programs Deadlines  - chart.dThe year of 2013 marks the beginning of a critical period for optometrists who treat Medicare patients. Actions that optometrists take in 2013, 2014 and 2015 will impact whether Physician Quality Reporting System (PQRS) and Electronic Health Record (EHR) Incentive Program penalties are assessed.

Here are the key dates and other information that optometrists should be aware of to earn incentives and avoid payment penalties.

Medicare EHR Incentive Program dates

Oct. 3, 2013

  • For ODs who have never participated in the Medicare EHR incentive Program, Oct. 3 is the last day to begin a 90-day reporting period for 2013.

June 30, 2014

  • Applicable optometrists can avoid the 2015 Medicare EHR program payment adjustment by applying for an exemption by June 30, 2014.

July 1, 2014

  • Practitioners may earn an EHR incentive in 2014 and avoid the 2015 and 2016 Medicare EHR payment adjustment if they begin their 90-day meaningful use reporting period by July 1, 2014.

PQRS Incentive Programs key dates

Jan. 1, 2013

  • 2013 PQRS program year begins.
  • A 0.5 percent incentive bonus is available for optometrists who successfully meet PQRS reporting requirements in 2013.

July 1, 2013

  • Registration will open for optometrists who would like CMS to calculate their PQRS quality performance based on administrative claims. The CMS-calculated administrative claims reporting option requires no additional work after signing up. For individual optometrists and for small groups with fewer than 100 PQRS eligible practitioners, signing up for the administrative claims reporting option will avoid the 2015 PQRS payment penalty. Optometrists who choose this reporting method are not eligible for a PQRS incentive bonus.
  • For practices that have more than 100 practitioners eligible to participate in PQRS, registration will open so that the practice can report to CMS which of the three methods of PQRS group reporting they will use for 2013. The group reporting methods include: the web-interface group reporting option, a registry, or request that CMS calculate the group’s performance on quality measures from administrative claims.
  • For practices that have more than 100 PQRS eligible practitioners, the practice will also be able to report to CMS whether they choose to participate in quality tiering for the value based modifier program. Quality tiering will determine if group performance is statistically better, the same, or worse than the national mean. By choosing to participate in quality tiering the practice could either receive a positive or negative 2015 payment adjustment related to the value based modifier.

Oct. 15, 2013

  • Deadline for electing the administrative claims option.
  • Deadline for group practices consisting of 100 or more practitioners eligible to participate in PQRS to communicate to CMS their 2013 reporting method.
  • Deadline for groups consisting of 100 PQRS eligible practitioners to elect quality-tiering for the value based modifier.

December 31, 2013

  • 2013 PQRS program year ends.
  • End of period to avoid 2015 PQRS payment adjustment.

Jan. 1, 2015

  • Optometrists who do not successfully meet the PQRS requirements for avoiding the payment adjustment in 2013 will receive 98.5 percent of his/her allowed Medicare Part B PFS amount for covered services.

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