Medical Billing: Changes in 2015 Medicare Physicians Fee Schedule

Medical Billing: Changes in 2015 Medicare Physicians Fee Schedule

There are major changes in Medicare and the 2015 Medicare Physician Fee Schedule (PFS) offers much of what is proposed for the Physician Quality Reporting System (PQRS) and the Value-Based Modifier Program (VBM).

It’s important for physicians to remember that as in 2014, it is mandatory that one successfully participate in the 2015 PQRS program order to be a part and reap the rewards the of VBM program. If you do not participate, then you’re faced with Medicare payment reductions.

Reductions and Changes in the PQRS Program

• There will be no bonus incentive in 2016 for successful 2015 PQRS participation
• Medicare payments in 2016 will be reduced by -2.0 percent if one does not successfully participate in 2015 PQRS.
• Reporting mechanisms for programs include medical claims; qualified registry; EHR; Group Practice Reporting Option (GPRO) web interface; certified survey vendors for the CAHPS for PQRS survey measures; and the QCDR.
• 20 new individual measures have been added
• 50 individual measures removed
• There are now a total of 255 measures
• 2 new measures groups added– Sinusitis and Acute Otitis Eterna
• 4 measures groups have been dropped- perioperative care; back pain; cardiovascular prevention; and Ischemic Vascular Disease (IVD).
• Those qualified medical personnel who see at least one Medicare patient must report on at least 1 measure from the crosscutting measures set. There are 19 crosscutting measures from which one may choose.
• Any group practice of 25 eligible professionals (EPs) or more using the GPRO web interface must report on a sample of 248 beneficiary patients.

Changes in VBM Program

The payment adjustment year for the VBM Program will be 2017 and it will be based on performance in 2015. At that time, reductions will be made as will upward adjustments for those who successfully participate. These include:

• Group Practices with two or more EPs.
• Physicians who are solo practitioners (SPs)
• Non-physician EPs in GPs with two or more EPs

The Impact

As these programs have been finalized, it’s easier to understand how underperformance may affect a practice in terms of Medicare payments. Reductions will range from 7% to 9%. As incentives and programs are adjusted, medical practitioners may be forced to compensate in other ways for lost revenues.

Also, these ongoing and new programs demand even more record keeping in an industry that already is overburdened by electronic paper. But accurate record keeping will be an essential part of these programs, as it is important in the success of any and all medical practices.

Solutions Offered

If your practice is feeling the burden of additional documentation demands, as well as the stress associated with changing databases, methods of reporting, and compliance with HIPAA, contact Medical Practice Management Resources, Inc.

We will discuss your challenges and offer solutions to the changes that have taken effect and those that are in the future. We will ably ensure our medical billing and coding processes will meet all industry standards and will offer you the best opportunity to receive the medical claims reimbursements that you deserve.

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