Oct. 15, 2013 is the deadline to register for the Centers for Medicare and Medicaid Services (CMS) Physician Value-PQRS (PV-PQRS) Registration System. It’s a new application to serve the Physician Value Modifier and PQRS programs that, according to CMS, will allow:
- Physician group practices to select their CY 2013 PQRS Group Reporting Mechanism and, if the group has 100 or more eligible professionals, elect quality tiering to calculate their CY 2015 Value-based Payment Modifier
- Individual eligible professionals to select the CMS-calculated Administrative Claims reporting mechanism for CY 2013 in order to avoid the PQRS negative payment
If missed, this deadline could impact your radiation oncology medical revenue cycle management and ultimately the financial health of your practice.
2013 is the first year that non-participation in PQRS will result in penalties causing reduced payments to your practice. Your radiation oncology practice performance in 2013 will dictate whether you are penalized and your payment is reduced beginning in 2015. While PQRS participation is voluntary, meeting the requirements not only optimizes your revenue stream it also demonstrates the quality care you provide. It all begins with registering and finding the right quality measure to report.
While bonuses of 0.5% will be awarded through 2014, they are being replaced in 2015 with penalties for non-compliance. These penalties are scheduled to rise to 2% of total individual physician Medicare payments in 2016.
The Journal of the American College of Radiology’s (JACR) conducted a study entitled “Medicare’s Physician Quality Reporting System: Early National Radiologist Experience and Near-Future Performance Projections,” evaluating the PQRS experience of radiation oncologists.
Key points from the 2010 (latest available) study, as reported in the February 2013 edition of Radiation Oncology Policy Update, include:
- Only a minority of radiologists successfully qualified for incentives under PQRS, but that number has increased each year.
- Those using registry (rather than claims-based) reporting systems were more likely to receive bonuses.
- Physician and practice improvements in documentation and reporting, respectively, will be necessary to avert widespread near-future physician penalties.
- The mean 2010 incentive bonus for radiation oncologists was $12,704.38 (the most current figures available to date).
- Between 2007 and 2010, radiation oncology eligibility increased 28.7% (from 3,457 to 4,448), participation increased 91.7% (from 519 to 995), and qualification increased 302.9% (from 139 to 560).
- Although only 23.7% of eligible radiologists qualified for PQRS incentives in 2010, radiologists overall fared more favorably than non-radiologists. The only non-radiology specialties that exceeded radiologists’ qualification rates for eligible physicians in 2010 were emergency medicine (56.4%), pathology (43.4%), thoracic and cardiac surgery (31.4%), anesthesiology (30.6%), cardiology (28.6%), and ophthalmology (27.6%).
- Assuming steady-state conditions, on average, 13% of radiation oncologists would be eligible for annual bonuses of $2,010 for 2013 – 2014 and 87% of radiation oncologists would be subject to penalties of $6,029 and $8,039 in 2015 and 2016, respectively.
American Taxpayer Relief Act (ATRA) Registry Provision
When deciding on the best quality measure to report, here’s why the right radiation oncology coding, billing and collections firm specializing in PQRS and all other radiation oncology compliance plays a critical role. They help to select the reporting measure right for you and your medical revenue cycle management that stays abreast of all PQRS guidelines to maximize your payments by avoiding penalties.
Those who choose to participate individually must report on individual Physician Quality Reporting quality measures or measures groups through Medicare Part B claims, a qualified Physician Quality Reporting registry, or a qualified electronic health record. Those who choose to participate as a group can only report individual measures using a CMS-qualified PQRS registry or for groups of 25 plus eligible professionals through a web interface.
The criteria for obtaining an incentive for 2013 is as follows:
- Claims based—50 percent of applicable part B patients
- Registry based—80 percent of applicable part B patients
- EHR based—80 percent of applicable part B patients
Let’s face it, your radiation oncology practice healthcare revenue cycle management may be more vulnerable with all of these new PQRS requirements unless you have an independent, third party insider that understands all the nuances in radiation oncology compliance. revMD.com stays current on federal guidelines and changes in quality reporting measures and all other compliance areas. They protect you from reduced payments resulting from incomplete data reporting, whether you are a practice of 2, 20 or 200.
revMD.com is the results-proven alternative for healthcare revenue cycle management, with a niche specialization in radiation oncology medical practice coding that generates unprecedented results and builds profitable medical practices. Not only is revMD.com the industry expert in physician medical coding, billing and collections, they are the professionals in PQRS compliance and seamless ICD-10 implementation. Leveraging a history of industry wide success spanning 26 years, revMD.com partners with medical practices throughout the U.S. to optimize revenue for hospital based and practice based physicians. For more information, visit www.revmd.com.