Bonuses, penalties become important factors in Medicare payment
June 3, 2011Taken together, Medicare’s three payment incentive programs – the MedicarePhysician Quality Reporting System (PQRS), Medicare e-Prescribing Incentive Program, and Medicare Electronic Health Records (EHR) Incentive Program – can make a notable difference in the total reimbursements health care practitioners receive from the government health plan, according to the U.S. Centers for Medicare & Medicaid Services (CMS).
The agency last month outlined the bonuses and penalties authorized under the three programs in a new Medicare EHR Incentive Program, Physician Quality Reporting System and e-Prescribing Comparison.
Depending on which of the incentive programs they participate in during 2011, health care practitioners could earn bonuses equalling up to 2 percent of their total Medicare allowed charges for the year, or $18,000 plus 1 percent of their total Medicare allowed charges, according to the CMS.
Health care practitioners who do not participate in the incentive programs will begin to see reimbursements cut over the coming years, the agency notes. By the year 2019, they will risk losing up to 9 percent of their total Medicare payments.
Optometrists should begin taking part in Medicare programs as quickly as practical to earn maximum payments and avoid penalties, according to AOA President Joe Ellis, O.D.
“A 1 percent or 2 percent increase in Medicare payments may not always sound like much,” Dr. Ellis observers. “However, over the coming years, such percentage increases could begin to add up.”
Medicare plans to move toward more “pay-for-performance” or “value-oriented” reimbursement systems, Dr. Ellis notes. “Instead of basing reimbursements solely on a fixed, fee-for-service payment schedule, Medicare plans to reward practitioners for meeting performance measures designed to improve health care quality and efficacy,” Dr. Ellis notes.
Practitioners who do not meet those performance measures will be increasingly subject to penalties. Similar programs are being implemented by other public and private health insurance plans. Even a 1 percent or 2 percent bonus could be important to a practice, Dr. Ellis noted.
“With 2011 Medicare reimbursements rates frozen at 2010 levels, a 2 percent bonus would effectively mean Medicare reimbursement would increase at about the rate of inflation. That could be important in maintaining a practice’s bottom line.” Dr. Ellis said.
Since 2001, Congress has not authorized a physician fee schedule update of more than 2 percent, and during that time Medicare rates fell 16 percent compared to inflation.
Each of the Medicare incentive programs comes with rules and regulations that practitioners should understand, Dr. Ellis noted.
Practitioners cannot qualify for bonuses under both the Medicare EHR and e-Rx Incentive programs in the same year but can be subject to penalties under both programs in the same year. The CMS has indicated that optometrists, unlike most other physicians, will not be subject to e-prescribing penalties in 2012.
Detailed information on participation by optometrists in the Medicare incentive programs can be found on the AOA Web site (www.aoa.org ).
The Medicare EHR Incentive Program, Physician Quality Reporting System and e-Prescribing Comparison can be accessed on the CMS Web site. (www.cms.gov/MLNProducts/downloads/EHRIncentivePayments-ICN903691.pdf).
