Medicare PQRS payment update

Medicare Physician Fee Schedule Update 2012:


In 2012, the Centers for Medicare & Medicaid Services (CMS) is implementing payment updates and policy changes to the Medicare Physician Fee Schedule, including:

• Policies and procedures to identify and provide accurate payment for misvalued services; and

• Changes to the factors used to adjust physician fee schedule payment for geographic differences in physicians’ practice costs.

Incentives and Payment Adjustments for Quality Reporting:

We are continuing our efforts to promote improvement in quality of care and patient outcomes through the Electronic Prescribing (eRx) Incentive Program and the Physician Quality Reporting System (PQRS). Eligible professionals or group practices that meet satisfactory reporting requirements under the PQRS in calendar year (CY) 2011 will be eligible for incentive payments equal to 1.0 percent of their total estimated allowed charges for the reporting period. This incentive payment will be made in CY 2012.

In addition, eligible professionals or group practices that meet satisfactory reporting requirements under the PQRS in CY 2012 will be eligible for incentive payments equal to 0.5 percent of their total estimated allowed charges for the reporting period.

Eligible professionals or group practices that meet the requirements of the eRx Incentive Program in CY 2011 will be eligible for incentive payments equal to 1.0 of their total estimated allowed charges for the reporting period. Similar to the PQRS, this incentive payment will be made in CY 2012. In addition, eligible professionals or group practices that meet the requirements of the eRx Incentive Program in CY 2012 will be eligible for incentive payments equal to 1.0 percent of their total estimated allowed charges for the reporting period.

Eligible professionals who did not become successful electronic prescribers by reporting on the electronic prescribing measure for at least 10 unique events from January 1, 2011, through June 30, 2011, or were not granted an exemption due to a significant hardship will be subject to a negative payment adjustment equal to 1.0 percent of their fee schedule amounts for covered professional services furnished during 2012. Feedback reports based on information reported by eligibleprofessionals to CMS during the 2012 eRx payment adjustment reporting period (i.e., January 1, 2011- June 30, 2011) are expected to be made available to eligible professionals in late-2011.

In addition, a negative payment adjustment equal to 1.5 percent of the physician fee schedule amounts for covered professional services furnished during 2013 will apply to eligible professionals unless:

(1) the eligible professional was a successful electronic prescriber for purposes of the 2011 eRx incentive;

(2) the eligible professional becomes a successful electronic prescriber by reporting on the electronic prescribing measure on at least 10 unique events (which need not be associated with the measure’s
denominator) from January 1, 2012, through June 30, 2012; or

(3) the eligible professional was granted an exemption due to a significant hardship.